-----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, AWHc5k5JKSj08jeVHe6GEJGo1DebhFXJxlO1/v94zYVxvHdApCBZl8B6t7I8XSO4 24qLwhqDStlhSEimz95gIw== 0000901845-04-000006.txt : 20040923 0000901845-04-000006.hdr.sgml : 20040923 20040923212114 ACCESSION NUMBER: 0000901845-04-000006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040922 FILED AS OF DATE: 20040923 DATE AS OF CHANGE: 20040923 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BURLINGTON COAT FACTORY WAREHOUSE CORP CENTRAL INDEX KEY: 0000718916 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DEPARTMENT STORES [5311] IRS NUMBER: 221970303 STATE OF INCORPORATION: DE FISCAL YEAR END: 0530 BUSINESS ADDRESS: STREET 1: 1830 RTE 130 CITY: BURLINGTON STATE: NJ ZIP: 08016 BUSINESS PHONE: 6093877800 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILSTEIN ANDREW R CENTRAL INDEX KEY: 0000901845 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08739 FILM NUMBER: 041043809 BUSINESS ADDRESS: STREET 1: C/O BURLINGTON COAT FACTORY WAREHOUSE CO STREET 2: 1830 ROUTE 130 CITY: BURLINGTON STATE: NJ ZIP: 08016 BUSINESS PHONE: 6093877800 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-09-22 0 0000718916 BURLINGTON COAT FACTORY WAREHOUSE CORP BCF 0000901845 MILSTEIN ANDREW R 1830 RT. 130 BURLINGTON NJ 08016 1 1 1 0 Executive Vice President Common Stock, $1.00 Par Value 2004-09-22 4 G 0 6743984 0 A 6743984 I By spouse Common Stock, $1.00 Par Value 2780251 D Common Stock, $1.00 Par Value 132355 I See footnote Represents shares in which the reporting person's spouse may be deemed to have an indirect interest. On September 10, 2004, the reporting person's spouse was appointed trustee of the Trust Established Under Article SIXTH of the Last Will and Testament of Henrietta Milstein (the "Trust"). On September 22, 2004, the Estate of Henrietta Milstein, pursuant to the terms of the last will and testament of Henrietta Milstein, transferred 6,743,984 shares of issuer common stock to the Trust. The reporting person's spouse may be deemed to have an indirect beneficial interest in the shares held by the Trust because the reporting person's father, Monroe Milstein, is a beneficiary under the Trust. The reporting person disclaims any such interest. Includes 37,306 shares held by the Andrew Milstein Trust and 9,446 shares held by the AHM Trust and 9,675 shares held by the DJM Trust, trusts established for the benefit of the children of Andrew Milstein. Such shares are reported by reason of Rule 16a-1(a)(2)(ii)(A), but Andrew Milstein disclaims any pecuniary interest in such shares. This also includes 75,928 shares owned by Samgray, L.P., a limited partnership. Andrew Milstein, as a member of Latzim Family, LLC (the general partner of Samgray, L.P.) and as a limited partner of Samgray, L.P., has a pecuniary interest in these shares. /s/ Andrew Milstein 2004-09-23 -----END PRIVACY-ENHANCED MESSAGE-----