5 1 0001.txt OMB Number 3235-0362 Expires: September 30, 1998 Estimated average burden hours per response 1.0 FORM 5 / / Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). / / Form 3 Holdings Reported /X/ Form 4 Holdings Reported U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D. C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 (Print or Type Responses) 1. Name and Address of Reporting Person* Gruber, Jon D., 50 Osgood Place, San Francisco, CA 94133_ (Last) (First) (Middle), (Street), (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol _Monterey Pasta (PSTA) 3. IRS or Social Security Number of Reporting Person (Voluntary) ______ 4. Statement for Month/Year December 31, 2000 5. If Amendment, Date of Original (Month/Year) ___________ 6. Relationship of reporting person to issuer (Check all applicable) ____ Director __X_ 10% Owner ____ Officer (give ____ Other (specify title below) below) ______________________ 7. Individual or Joint/Group Filing (Check Applicable line) __X__ Form filed by one Reporting Person ____ Form filed by More than One Reporting Person SEC 2270 (9-96) FORM 5 (continued) Page _2_ of _16_ Pages Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __2/4/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __1000__ (A) or (D) ___A___ Price ___3.68____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) _2/7/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __2900__ (A) or (D) ___A___ Price __3.86_____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___2/8/00____ 3. Transaction Code (Instr. 8) ____P4______ FORM 5 (continued) Page _3_ of _16_ Pages 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _19,800_ (A) or (D) ___A___ Price ___3.86____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___2/11/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _12,100___ (A) or (D) ___A___ Price __3.75___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __2/11/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _5,000__ (A) or (D) ___A___ Price __3.84___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ FORM 5 (continued) Page _4_ of _16_ Pages 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___2/29/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __2500_ (A) or (D) ___A___ Price __3.38____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __3/1/00_____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _1500__ (A) or (D) ___A___ Price _3.80_____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __3/3/00______ 3. Transaction Code (Instr. 8) ____P4______ FORM 5 (continued) Page _5_ of _16_ Pages 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __5000__ (A) or (D) ___A___ Price __3.84___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __4/20/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __3000__ (A) or (D) ___A___ Price __4.05____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __7/21/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _2800___ (A) or (D) ___A___ Price ___4.11____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ FORM 5 (continued) Page _6_ of _16_ Pages 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __7/31/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _1500___ (A) or (D) ___A___ Price __4.07____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___8/3/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _6500__ (A) or (D) ___A___ Price __4.30___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __9/5/00____ 3. Transaction Code (Instr. 8) ____P4______ FORM 5 (continued) Page _7_ of _16_ Pages 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount ___4500 (A) or (D) ___A___ Price _4.73______ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____298,900____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______D_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __2/4/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __4400__ (A) or (D) ___A___ Price ___3.68____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) _2/7/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __8000__ (A) or (D) ___A___ Price __3.86_____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) FORM 5 (continued) Page _16_ of _16_ Pages 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___2/8/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _203,300_ (A) or (D) ___A___ Price ___3.86____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___2/11/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _330,000___ (A) or (D) ___A___ Price __3.75___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __2/11/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _18,000__ (A) or (D) ___A___ Price __3.84___ FORM 5 (continued) Page _9_ of _16_ Pages 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___2/29/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __10,000_ (A) or (D) ___A___ Price __3.38____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___3/1/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _3000__ (A) or (D) ___A___ Price ___3.50___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __3/1/00_____ FORM 5 (continued) Page _16_ of _16_ Pages 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _1500__ (A) or (D) ___A___ Price _3.80_____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __3/3/00______ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __11,000__ (A) or (D) ___A___ Price __3.84___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___4/6/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _2300_ (A) or (D) ___A___ Price __3.80____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ FORM 5 (continued) Page _11_ of _16_ Pages 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___4/7/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _2000__ (A) or (D) ___A___ Price __3.92___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __4/20/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __15,000__ (A) or (D) ___A___ Price __4.05____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __4/26/00____ 3. Transaction Code (Instr. 8) ____P4______ FORM 5 (continued) Page _12_ of _16_ Pages 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _19,200__ (A) or (D) ___A___ Price __4.13___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __5/11/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _3600__ (A) or (D) ___A___ Price ___3.98___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __7/21/00___ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _4000___ (A) or (D) ___A___ Price ___4.11____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ FORM 5 (continued) Page _13_ of _16_ Pages 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __7/31/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _3500___ (A) or (D) ___A___ Price __4.07____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) ___8/3/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount _11,700__ (A) or (D) ___A___ Price __4.30___ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __8/24/00___ 3. Transaction Code (Instr. 8) ____P4______ FORM 5 (continued) Page _14_ of _16_ Pages 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount __3000__ (A) or (D) ___A___ Price __4.36_____ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) 1. Title of Security (Instr. 3) ___Common Stock______________ 2. Transaction Date (Month/Day/Year) __9/5/00____ 3. Transaction Code (Instr. 8) ____P4______ 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) Amount ___15,000 (A) or (D) ___A___ Price _4.73______ 5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Inst. 3 and 4) ____2,025,400____ 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) ______I_______ 7. Nature of Indirect Beneficial Ownership (Inst. 4) (1)(2) * If the form is filed by more than one reporting person, see Instruction 4(b)(v). SEC 1474 (7- 96) FORM 5 (continued) Page _15_ of _16_ Pages Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security (Instr. 3) _____________________________ 2. Conversion or Exercise Price of Derivative Security _______________ 3. Transaction Date (Month/Day/Year) ______________ 4. Transaction Code (Instr. 8) __________________ 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) (A) _____________ (D) ______________ 6. Date Exercisable and Expiration Date (Month/Day/Year) Date Exercisable Expiration Date ____________________ ________________________ 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) Title ______________________ Amount or Number of Shares ________ 8. Price of Derivative Security (Instr. 5) _______________ 9. Number of Derivative Securities Beneficially Owned at End of Year (Instr. 4) _______________ 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) __________________ 11. Nature of Indirect Beneficial Ownership (Inst. 4) _____________________________________________________________________ __________________________________________________________________________ FORM 5 (continued) Page _16_ of _16_ Pages Explanation of Responses: (1) As manager of Gruber & McBaine Capital Management, LLC, a limited liability company that is a general partner of investment partnerships and investment adviser to client accounts. The securities with respect to which indirect beneficial ownership is reported are owned directly by the partnerships and client accounts. (2) The reporting person disclaims beneficial ownership of the securities with respect to which indirect beneficial ownership is reported, except to the extent of the reporting person's pro rata pecuniary interest therein. /s/ Jon D. Gruber 2/10/01 **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure. 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. SEC 2270 (9-96) CSR\2217\006\1134189.01