-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, JguOu8mhFIeWjiWLeVgJSvr0OlrbQiRGPrP5nJGhgXrgDP36D4mLe6A0pwICcYve 1lo0beol9R+FxXB9VoUz8Q== 0000950129-99-004629.txt : 19991027 0000950129-99-004629.hdr.sgml : 19991027 ACCESSION NUMBER: 0000950129-99-004629 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991020 FILED AS OF DATE: 19991026 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PETROQUEST ENERGY INC CENTRAL INDEX KEY: 0000872248 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 980115468 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-19020 FILM NUMBER: 99734152 BUSINESS ADDRESS: STREET 1: 625 E KALISTE SALOOM ROAD SUITE 400 CITY: LAFAYETTE STATE: LA ZIP: 70508 BUSINESS PHONE: 3182327028 MAIL ADDRESS: STREET 1: 600 595 HOWE ST STREET 2: VANCOUVER BRITISH COLUMBIA CITY: CANADA V6C 2T5 STATE: A1 FORMER COMPANY: FORMER CONFORMED NAME: OPTIMA PETROLEUM CORP DATE OF NAME CHANGE: 19950726 COMPANY DATA: COMPANY CONFORMED NAME: RUCKS WILLIAM W IV CENTRAL INDEX KEY: 0000939484 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 600 JEFFERSON STREET STREET 2: SUITE 701 CITY: LAFAYETTE STATE: LA ZIP: 70501 BUSINESS PHONE: 3182328460 MAIL ADDRESS: STREET 1: 600 JEFFERSON STREET SUITE 701 CITY: LAFAYETTE STATE: LA ZIP: 70501 3 1 WILLIAM W. RUCKS, IV FOR PETROQUEST ENERGY, INC. 1 -------------------------- OMB APPROVAL -------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: December 31, 2001 - -------- Estimated average burden hours per response.... 0.5 -------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 - ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Statement Trading Symbol of Original RUCKS, IV WILLIAM W. (Month/Day/Year) PETROQUEST ENERGY, INC (PQUE) (Month/Day/Year) - ---------------------------------------- ------------------------------------ (Last) (First) (Middle) 10/20/99 5. Relationship of Reporting ----------------------- FIRST NATIONAL BANK TOWERS, BOX 11, ---------------------------- Person(s) to Issuer 7. Individual or Joint/ 600 JEFFERSON, SUITE 701 3. I.R.S. Identification (Check all applicable) Group Filing (Check - ---------------------------------------- Number of Reporting X Director 10% Owner Applicable Line) (Street) Person, if an entity ----- ----- X Form filed by (voluntary) Officer Other (specify --- One Reporting LAYFAYETTE LOUISIANA 70505 ----- ----- below) Person - -------------------------------------- ---------------------------- (give title below) Form filed by (City) (State) (Zip) --- More than One ------------------------------ Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK 480,000 D - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (3-99) POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTIONS OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER.
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security Direct ------------------------------------------------- (D) or Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Warrant to Purchase Shares of Common Stock of PetroQuest Energy, Inc. 8/3/99 8/2/03 Common Stock 225,000 $ 1.25 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ William W. Rucks, IV 10/26/99 **Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- ------------- Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Note. File three copies of this Form, one of which must be manually signed. Page 2 If space is insufficient, See Instruction 6 for procedure. SEC 1473 (3-99)
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. -----END PRIVACY-ENHANCED MESSAGE-----