-----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, EY+uYnJZSFoYS4IZOTlhtU7hNQQvfc7s6rz7O1kQ6OqpqmhdC5shA85Ov+Hc57Zx 3EFsDt/Xd9IaCr4vu6d8dQ== 0000910117-97-000053.txt : 19970222 0000910117-97-000053.hdr.sgml : 19970222 ACCESSION NUMBER: 0000910117-97-000053 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970214 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: COFFEE PEOPLE INC CENTRAL INDEX KEY: 0000925908 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING & DRINKING PLACES [5810] IRS NUMBER: 931073218 STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-47029 FILM NUMBER: 97533448 BUSINESS ADDRESS: STREET 1: 3259 NW 29TH AVE CITY: PORTLAND STATE: OR ZIP: 97210 BUSINESS PHONE: 5032237714 MAIL ADDRESS: STREET 1: 3529 NW 29TH FL CITY: PORTLAND STATE: OR ZIP: 97210 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: ROBERTS PATRICIA J CENTRAL INDEX KEY: 0001031161 STANDARD INDUSTRIAL CLASSIFICATION: [] STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 3259 NW 29TH AVENUE CITY: PORTLAND STATE: OR ZIP: 97210 BUSINESS PHONE: 5032237714 MAIL ADDRESS: STREET 1: 3259 NW 29TH AVENUE CITY: PORTLAND STATE: OR ZIP: 97210 SC 13G 1 SCHEDULE 13G - PATRICIA ROBERTS UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. )* Coffee People, Inc. (Name of Issuer) Common Stock, No Par Value (Title of Class of Securities) 192189 10 8 (CUSIP Number) * The remainder of this cover page shall be filled out for a reporting persons's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). CUSIP No. 192189 10 8 Item 1: Name of reporting person; S.S. or I.R.S. identification no. of above person: Patricia J. Roberts; ###-##-#### Item 2: Check the appropriate box if a member of a group: (a) [ ] (b) [ ] Item 3: SEC use only: Item 4: Citizenship or place of organization: United States of America Number of shares beneficially owned by each reporting person with: Item 5: Sole voting power: 193,750 Item 6: Shared voting power: 0 Item 7: Sole dispositive power: 193,750 Item 8: Shared dispositive power: 0 Item 9: Aggregate amount beneficially owned by each reporting person: 193,750 Item 10: Check box if the aggregate amount in row (9) excludes certain shares: [x] 193,750 shares are owned by the reporting person's spouse Item 11: Percent of class represented by amount in row 9: 6.0% Item 12: Type of reporting person: IN Item 1(a): Name of issuer: Coffee People, Inc. Item 1(b): Address of Issuer's Principal Executive Offices: 3259 N.W. 29th Avenue Portland, OR 97210 Item 2(a): Name of Person Filing: Patricia J. Roberts Item 2(b): Address of Principal Business Office, or, if none, Residence: 3259 N.W. 29th Avenue Portland, OR 97210 Item 2(c): Citizenship: United States of America Item 2(d): Title of Class of Securities: Common Stock Item 2(e): CUSIP Number: 192189 10 8 Item 3: If this statement is filed pursuant to Rules 13d-1(b) or 13d-2(b), check whether the person filing is a: Not applicable Item 4: Ownership. The following information is as of December 31, 1996: (a) Amount Beneficially Owned: 193,750 shares (b) Percent of Class: The shares represent 6 percent of the class (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote: 193,750 (ii) Shared power to vote or to direct the vote: 0 (iii) Sole power to dispose or to direct the disposition of: 193,750 (iv) Shared power to dispose or to direct the disposition of: 0 Item 5: Ownership of Five Percent of Less of a Class: Not applicable Item 6: Ownership of More than Five Percent on Behalf of Another Person: Not applicable Item 7: Identification and Classification of the Subsidiary which Acquired the Security Being Reported on by the Parent Holding Company: Not applicable Item 8: Identification and Classification of Members of the Group: Not applicable Item 9: Notice of Dissolution of Group: Not applicable Item 10: Certification: Not applicable SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete, and correct. February , 1997 /s/ Patricia J. Roberts ------------------------------ Patricia J. Roberts ATTENTION: Intentional misstatements or omissions of fact constitute federal criminal violations (see 18 USC 1001) -----END PRIVACY-ENHANCED MESSAGE-----