-----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, TFXOh+451e/0VdkhMnJgjhOsWnA/ncEq/g63IWMg/uS9K+J8JjgI31ao3gXMe5UA Pi33CtHyT0BHHKeGhDvUJQ== 0001158205-01-500002.txt : 20010911 0001158205-01-500002.hdr.sgml : 20010911 ACCESSION NUMBER: 0001158205-01-500002 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010801 FILED AS OF DATE: 20010910 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PACIFIC SYSTEMS CONTROL TECHNOLOGY INC /DE/ CENTRAL INDEX KEY: 0001034840 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MOTION PICTURE & VIDEO TAPE PRODUCTION [7812] IRS NUMBER: 943261987 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22833 FILM NUMBER: 1735057 BUSINESS ADDRESS: STREET 1: 22320 FOOTHILL BLVD. STREET 2: SUITE 260 CITY: HAYWARD STATE: CA ZIP: 94541 BUSINESS PHONE: 5107280200 MAIL ADDRESS: STREET 1: 22320 FOOTHILL BLVD. STREET 2: SUITE 260 CITY: HAYWARD STATE: CA ZIP: 94541 FORMER COMPANY: FORMER CONFORMED NAME: AMERICAN CHAMPION ENTERTAINMENT INC DATE OF NAME CHANGE: 19970228 COMPANY DATA: COMPANY CONFORMED NAME: LARSON ROBERT E CENTRAL INDEX KEY: 0001158205 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: PACIFIC SYSTEMS CONTROL TECHNOGY INC STREET 2: 22320 FOOTHILL BLVD STE 260 CITY: HAYWARD STATE: CA ZIP: 94541 BUSINESS PHONE: 15107280200 MAIL ADDRESS: STREET 1: PACIFIC SYSTEMS CONTROL TECH STREET 2: 22320 FOOTHILL BLVD STE 260 CITY: HYWARD STATE: CA ZIP: 94541 3 1 body3rl.htm BODY FORM 3 Form3 Larson

FORM 3

U.S. SECURITIES AND EXCHANGE COMMISSION

OMB APPROVAL

 

Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB Number: 3235-0104
Expires: April 30, 1997
Estimated average burden hours per response 0.5

 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  

Robert E. Larson

2. Date of Event Requiring Statement

(Month/Day/Year)

08/01/2001
  1. Issuer Name and Ticker or Trading Symbol

Pacific Systems Control Technology, Inc.     PFSY

(Last) (First) (Middle)

22320 Foothill Boulevard, Suite 260

3. IRS or Social Security Number of Reporting Person (Voluntary)

5. Relationship of Reporting Person to Issuer

(Check all applicable)

__X_ Director ___ 10% Owner

____ Officer (give title below) ____ Other (specify below)

6. If Amendment, Date of Original
(Month/Day/Year)

(Street)

Hayward, CA 94541

(City)     (State)      (Zip)

Table I - Non-Derivative Securities Beneficially Owned

1. Title of Security
(Instr. 4)

 

2. Amount of Securities
Beneficially Owned
(Instr. 4)

3. Ownership
Form: Direct
(D) or Indirect
(I) (Instr. 5)

4. Nature of Indirect Beneficial Ownership
(Instr. 5)

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly (Over)

(Print or Type Responses) SEC 1473 (8-92)

FORM 3 (continued) Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)

 

1. Title of Derivative Security

(Instr. 4)

2. Date Exercisable
and Expiration Date (Month/Day/Year)

3. Title and Amount of Securities
Underlying Derivative Security
(Instr. 4)

4. Conversion or Exercise Price of Derivative Security

5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)

6. Nature of Indirect Beneficial Ownership (Instr. 5)

Date Exercisable

Expiration Date

 

Title

Amount or Number of Shares

Options

08/01/2001

 

07/31/2004

 

Common Stock

 

274,212

 

$0.15

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



       /s/ Robert E. Larson         , Member of Board of Directors      September 10, 2001
**Signature of Reporting Person                                                                    Date


Explanation of Responses:

** 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 provided is insufficient.
See Instruction 6 for procedure.

 

Page 2

SEC 1473 (8-92)





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