-----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, D9tXqWLugS11DdeRMtq8Rd++IUfmAlSvMuh9+IAG3k+q3hXFw0gKyZfPvQpiwsUz FfSCWVLhJ0KYGdUrsmUFrQ== /in/edgar/work/20000911/0000929638-00-000180/0000929638-00-000180.txt : 20000922 0000929638-00-000180.hdr.sgml : 20000922 ACCESSION NUMBER: 0000929638-00-000180 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000512 FILED AS OF DATE: 20000911 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SMARTSERV ONLINE INC CENTRAL INDEX KEY: 0001005698 STANDARD INDUSTRIAL CLASSIFICATION: [7374 ] IRS NUMBER: 133750708 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-28008 FILM NUMBER: 719925 BUSINESS ADDRESS: STREET 1: METRO CENTER STREET 2: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 BUSINESS PHONE: 2033535950 MAIL ADDRESS: STREET 1: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 COMPANY DATA: COMPANY CONFORMED NAME: KLOTZ CHARLES CENTRAL INDEX KEY: 0001122092 STANDARD INDUSTRIAL CLASSIFICATION: [ ]DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: BINGHAM DANA LLP STREET 2: 150 FEDERAL ST 19TH FL CITY: BOSTON STATE: MA ZIP: 02110 BUSINESS PHONE: 6179518797 MAIL ADDRESS: STREET 1: 19 ARLINGTON RD CITY: WELLESLEY STATE: MA ZIP: 02481 3 1 0001.txt INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SEC. U.S. SECURITIES AND EXCHANGE COMMISSION ---------------------- WASHINGTON D.C. 20549 OMB APPROVAL ---------------------- OMB Number: 3235-0104 - ------------ ---------------------- FORM 3 - ------------ 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 2. Date of Event Requiring 4. Issuer Name and Ticker or Trading Symbol Reporting Person Statement (Month/Day/Year) Klotz Charles R. May 12, 2000 SmartServ Online, Inc. (SSOL) - ----------------------------------------------------------------------------------------------------------------------------------- (Last)(First)(Middle) 3. IRS or Social Security 5. Relationship of Reporting 6. If Amendment, Date of 150 Federal Street, 19th Floor Number of Reporting Person to Issuer (check all Original (Month/Day/ - ------------------------------ Person (Voluntary) applicable) year) (Street) X Director __ 10% Owner _____________________________ -- __ Officer (give __ Other (specify 7. Individual or Joint/Group Boston, MA 02110 title below) below) Filing (Check Applicable Line) X Form filed by One Reporting Person __ Form filed by More than One Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security (Instruction 4) 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect Beneficially Owned Direct (D) or Indirect Beneficial Ownership (Instr. 4) (I)(Instr. 5) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 303,030 I (1) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
*If the Form is filed by more than one reporting person, See Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly (PRINT OR TYPE RESPONSES)
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Date Exercisable and 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of Security (Instr. 4) Expiration Date Securities Underlying or Exercise Form of Indirect (Month/Day/Year) Derivative Security Price of Derivative Beneficial (Instr. 4) Derivative Security: Ownership Security Direct (D) (Instr. 5) Indirect (I) (Instr. 5) --------------------------------------------------------------------------------------------------------- Date Expiration Amount or Exercisable Date Title Number of Shares - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- (1) These shares are owned by TecCapital Ltd., of which Mr. Klotz is a director. Mr. Klotz disclaims beneficial ownership of such shares and this report shall not be deemed an admission of beneficial ownership for purposes of Section 16 or for any other purpose.
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If the Form is filed by more than one reporting person, See Instruction 5(b)(v). **Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
/s/ Charles R. Klotz August 22, 2000 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ----------------------------------- -------------- **Signature of the Reporting Person Date
Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, See Instruction 6 for procedure. (Print or Type Responses) -----END PRIVACY-ENHANCED MESSAGE-----