-----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, Mmyl7g6d/Xd/0q8IuIdo5YO/efSXLlAmYMoQs8IHbI8jv6ZBN0CmKzRl4k/oW3qq 7/JRMPWIZYHWjl9xRjDLqg== 0001021771-04-000159.txt : 20041001 0001021771-04-000159.hdr.sgml : 20041001 20041001130425 ACCESSION NUMBER: 0001021771-04-000159 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040924 FILED AS OF DATE: 20041001 DATE AS OF CHANGE: 20041001 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SIEBALD JACK D CENTRAL INDEX KEY: 0001186619 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-01665 FILM NUMBER: 041057503 BUSINESS ADDRESS: STREET 1: 1336 BOXWOOD DRIVE WEST CITY: HEWLETT HARBOR STATE: NY ZIP: 11557 BUSINESS PHONE: 5167465718 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DCAP GROUP INC/ CENTRAL INDEX KEY: 0000033992 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 362476480 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 90 MERRICK AVE STREET 2: 9TH FLOOR CITY: EAST MEADOW STATE: NY ZIP: 11554 BUSINESS PHONE: 5167946300 MAIL ADDRESS: STREET 1: 90 MERRICK AVE 9TH FLOOR STREET 2: 90 MERRICK AVE 9TH FLOOR CITY: EAST MEADOW STATE: NY ZIP: 11554 FORMER COMPANY: FORMER CONFORMED NAME: EXTECH CORP DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: EXECUTIVE HOUSE INC DATE OF NAME CHANGE: 19911119 3 1 seibald92404_ex.xml X0202 3 2004-09-24 0 0000033992 DCAP GROUP INC/ DCAP.OB. 0001186619 SIEBALD JACK D 1336 BOXWOOD DRIVE WEST HEWLETT HARBOR NY 11557 1 0 0 0 Common Stock 113000 D Common Stock 3000 I . Common Stock 16160 I . Warrant 6.25 2003-07-10 2006-01-10 Common Stock 18750 I . Jointly owned with Mr. Seibald's wife. Represents shares owned by Boxwood FLTD Partners, a limited partnership of which Mr. Seibald and his wife are the general partners, and Mr. Seibald, his wife and his children are the limited partners. Represents Mr. Seibald's indirect proportionate interest in SDS Partners I, Ltd., a limited partnership that owns shares of the issuer. Mr. Seibald's interest in the limited partnership is held via a trust in which Mr. Seibald, his wife and his children have an interest. Mr. Seibald has been granted a power of attorney with respect to the shares owned by the limited partnership. Held in an individual retirement account for the benefit of Mr. Seibald. *This filing shall not be deemed an admission that the Reporting Person is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this statement. /s/ Jack D. Seibald 2004-10-01 -----END PRIVACY-ENHANCED MESSAGE-----