3 1 g77177e3.htm FLORIDA BANKS/ADAM HERBERT, JR Florida Banks/Adam Herbert, Jr
 

FORM 3

U.S. SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549
         
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 Reporting Person(1)   2. Date of Event Requiring Statement
(Month/Day/Year) 		  4. Issuer Name and Ticker or Trading Symbol
      Florida Banks, Inc. (FLBK)
(Last)(First)(Middle)
 
Herbert, Jr. Adam W.
  6/26/02  
5. Relationship of Reporting Person to Issuer

(Check all applicable)
  		      6. If Amendment, Date of Original
(Month/Day/Year)
(Street)
10901 Burnt Mill Rd., Apt. 1001
  3. IRS Number of Reporting Person, (Voluntary)
  		  x Director
o  Officer (give title below)
  		  o 10% Owner
o  Other (specify below)
  		   
(City)(State)(Zip)
 
Jacksonville, Florida 32256-2856
              7. Individual or Joint/Group Filing (Check applicable line)
x  Form filed by One Reporting Person
o  Form filed by
More Than
One Reporting
Person
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.  4)
Common Stock
  200   D    
 
           
 
           
 
           
 
           
 
           
 
           
 
           

(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)

(Over)

 

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 		   
                     
 
                   
 
                   
 
                   
 
                   
 
                   
 
                   
 
                   
 
                   
  
         
    /s/ Adam W. Herbert, Jr.   July 5, 2002
   
 
    ** 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 provided

is insufficient, See Instruction 6 for procedure.
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