3 1 form3devansd.txt FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 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 OMB Number: 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response.......0.5 (Print or Type Responses)
------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol Requiring Evans, David F. Statement UniComp, Inc. (UCMP) ----------------------------------------- (Month/Day/Year) -------------------------------------------------- (Last) (First) (Middle) May 14, 2002 5. Relationship of Reporting Person(s) to Issuer 15 West South Temple, Suite 1200 ----------------------------------------- -------------------- (Check all applicable) (Street) 3. IRS Identification ___ Director _X__ 10% Owner Number of ___ Officer (give ___ Other (specify Salt Lake City, Utah 84101 Reporting Person, title below) below) ----------------------------------------- if an entity ------------------------------------------------- (City) (State) (Zip) (voluntary) 6. If Amendment, Date of Original (Month/Day/Year) ------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person Form filed by More Than One Reporting Person --------------------------------------------------------------------------------------------------------------------------
Table I " Non-Derivative Securities Beneficially Owned
------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership (Instr. 4) Beneficially Owned Form: Direct (Instr. 5) (Instr. 4) (D) or Indirect (I)(Instr.5) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3,019,000 D ------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of (Over) securities beneficially owned directly or indirectly. SEC 1473 (2-99) * 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 2. Date Exercisable 3. Tile and Amount of 4. Conversion 5. Ownership 6. Nature of Security (Instr. 4) and Expiration Date Securities Underlying or Form of Indirect (Month/Day/Year) Derivative Security Exercise Derivative Beneficial (Instr. 4) Price of Security; Ownership Date Expiration Derivative Direct (D) (Instr. 5) Exercisable Date Title Amount or Security or Indirect Number of (I) Shares (Instr. 5) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to Purchase 5/14/02 5/14/07 Common Stock 3,000,000 $.025 D Common Stock ------------------------------------------------------------------------------------------------------------------------------------
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 is insufficient, See Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a current valid OMB Number. By: /s/ May 23, 2002 ----------------------------------- ------------ **Signature of Reporting Person Date Page 2 SEC 1473 (2-99)