-----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, RI3ocQZCIQX4uwxTa6MNLWmUFWuyPsnCkxL2rfvXqGZm0Q2e58IK/f+hzSeAROsZ Zi7P4hLnJBoi49P++YExPQ== 0000890566-96-001527.txt : 19961004 0000890566-96-001527.hdr.sgml : 19961004 ACCESSION NUMBER: 0000890566-96-001527 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19961003 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CARRIAGE SERVICES INC CENTRAL INDEX KEY: 0001016281 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PERSONAL SERVICES [7200] IRS NUMBER: 760423828 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-46723 FILM NUMBER: 96639069 BUSINESS ADDRESS: STREET 1: 1300 POST OAK BLVD SUITE 1500 CITY: HOUSTON STATE: TX ZIP: 77056 BUSINESS PHONE: 7135567400 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PAYNE MELVIN C CENTRAL INDEX KEY: 0001024177 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: C/O CARRAIGE SERVICES INC #1500 STREET 2: 1300 POST OAK BLVD CITY: HOUSTON STATE: TX ZIP: 77056 BUSINESS PHONE: 7135567400 MAIL ADDRESS: STREET 1: C/O CARRAIGE SERVICES INC #1500 STREET 2: 1300 POST OAK BLVD CITY: HOUSTON STATE: TX ZIP: 77056 SC 13G 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 CARRIAGE SERVICES, INC. (Name of Issuer) CLASS A COMMON STOCK, PAR VALUE $.01 PER SHARE (Title of Class of Securities) 143905-10-7 (CUSIP Number) Check the following box if a fee is being paid with this statement: [X]. CUSIP No. 143905-10-7 1) Name of Reporting Person Melvin C. Payne S.S. or I.R.S. Identification No. of Above Person 2) Check the appropriate box if a member of a Group (a)N/A (b)N/A 3) SEC Use Only 4) Citizenship or place of organization U.S.A. Number of Shares (5) Sole Voting Power 504,771 Beneficially Owned (6) Shared Voting Power 124,999 by Each Reporting (7) Sole Dispositive Power 504,771 Person with (8) Shared Dispositive Power 124,999 9) Aggregate Amount Beneficially Owned by Each Reporting Person 629,770 (represents shares of Class B Common Stock which are convertible at the holder's option into shares of Class A Common Stock on a share for share basis) 10) Check Box if the Aggregate Amount in Row (9) Excludes certain Shares N/A 11) Percent of Class Represented by Amount in Row 9 8.0% 12) Type of Reporting Person IN SCHEDULE 13G - TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULE 13d-1(c) Item 1(a). Name of Issuer: Carriage Services, Inc. Item 1(b). Address of Issuer's Principal Executive Offices: 1300 Post Oak Blvd., Suite 1500 Houston, Texas 77056 Item 2(a). Name of Person Filing: Melvin C. Payne Item 2(b). Address of Principal Business Office or, if None, Residence: 1300 Post Oak Blvd., Suite 1500 Houston, TX 77056 Item 2(c). Citizenship: U.S.A. Item 2(d). Title of Class of Securities: Class A Common Stock, par value $.01 per share Item 2(e). CUSIP Number: 143905-10-7 Item 3. This statement is filed pursuant to Rule 13d-1(c). Item 4. Ownership (a) Amount Beneficially Owned: 629,770 (represents shares of Class B Common Stock which are convertible at the holder's option into shares of Class A Common Stock on a share for share basis) (b) Percent of Class: 8.0% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote: 504,771 (ii) shared power to vote or to direct the vote: 124,999 (iii) sole power to dispose or to direct the disposition of: 504,771 (iv) shared power to dispose or to direct the disposition of: 124,999 Item 5. Ownership of Five Percent or 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 (statement is filed pursuant to Rule 13d-1(c)). 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. Dated: September 25, 1996 /s/ MELVIN C. PAYNE Melvin C. Payne -----END PRIVACY-ENHANCED MESSAGE-----