3 1 marcform3.htm FORM 3 marcform3

FORM 3

U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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 of Section 30(f) of the Investment Company Act of 1940

1.  Name and address of Reporting Person*

Mallis Marc Dr.

2.  Date of Event
     Requiring Statement
     (Month/Date/Year)
11/15/02
4.  Issuer Name and Ticker or Trading Symbol

Black Diamond Industries, Inc.

(Last)                     (First)                (Middle)

 

3.  I.R.S. Identification
     Number of Reporting
     Person, if an Entity
     (Voluntary)
5.  Relationship of Reporting Person to Issuer
     (Check all applicable)

[X] Director              [  ] 10% Owner
[  ] Officer (give         [  ] Other (specify
            title below)                 below)
_________________________________

6.  If Amendment, Date of
     Original
     (Month/Date/Year)
7.  Individual or
     Joint/Group Filing
     (Check applicable box)

[X ]  Form filed by One
      Reporting Person
[  ]  Form filed by more
       than one Reporting
       person

(Street)

2975 Rolling Woods Drive

(City)                   (State)                  (Zip)

Palm Harbor, Florida  34683

Table 1 - 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)
Common Stock, par value $0.001 700,000 I As General Partner and beneficiary of the Mallis Limited Partnership
       
       
       
       
       
       
       
       
       

(over)

Reminder:  Report on a separate line for each class of securities beneficially owned directly or indirectly.
                                                                           (Print or Type Responses)
*If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v).

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/Date/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
     (Inst. 5)
Date
Exercisable
Expiration
Date

Title

Amount or
Number of
Shares
None

 

           
               
               
               
               
               
               
               
               
               
               

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).

/s/ Dr. Marc Mallis
**Signature of Reporting Person 

November 25, 2002
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.