-----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, KGpzPaQ9qPIaMlxYmZtJnGtxiPXM/Datr0u3/f5w95fPF/fmYlGo0JQFAZrWchbU YjWnlfK24VsJtiMMTE5hUA== 0001097246-01-500224.txt : 20020412 0001097246-01-500224.hdr.sgml : 20020412 ACCESSION NUMBER: 0001097246-01-500224 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011120 FILED AS OF DATE: 20011205 COMPANY DATA: COMPANY CONFORMED NAME: JACOBSEN NEWTON W CENTRAL INDEX KEY: 0001163237 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 1052 GRAYSON RD CITY: PLEASANT HILL STATE: CA ZIP: 94523 BUSINESS PHONE: 530 756 5086 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MOLLER INTERNATIONAL INC CENTRAL INDEX KEY: 0000871344 STANDARD INDUSTRIAL CLASSIFICATION: AIRCRAFT [3721] IRS NUMBER: 680006075 STATE OF INCORPORATION: CA FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-33173 FILM NUMBER: 1807042 BUSINESS ADDRESS: STREET 1: 1222 RESEARCH PARK DR CITY: DAVIS STATE: CA ZIP: 95616 BUSINESS PHONE: 6307565086 MAIL ADDRESS: STREET 1: 1222 RESEARCH PARK DR CITY: DAVIS STATE: CA ZIP: 95616 3 1 newtonjacobsonform3.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 3 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 JACOBSON, NEWTON W. - -------------------------------------------- (last) (First) (Middle) 1052 GRAYSON RD. - -------------------------------------------- (Street) PLEASANT HILL, CALIFORNIA 94523 - -------------------------------------------- (city) (State) (Zip) 2. Date of Event Requiring Statement (month/Day/Year) 11/20/2001 - ------------------------------------------- 3. I.R.S. Identification Number of Reporting Person if entity (voluntary) N/A - -------------------------------------------- 4. Issuer Name And Ticker/Symbol MOLLER INTERNATIONAL, INC. - ------------------------------------------------ 5. Relationship of Reporting Person(s) to Issuer (check all applicable) X -----Director -----10% Owner -----Officer -----Other(specify) (give title below) - -------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) N/A - -------------------------------------------------- 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 (Instr. 4) Beneficially Owned Form: Direct Beneficial Ownership (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------- Common Stock 382,423 D - --------------------------------------------------------------------------------------------------
TABLE II - Derivative Securities Beneficially Owned (e,g, puts, calls, warrants, options, convertible securities)
- ------------------------------------------------------------------------------------------------------------------------------------ 5. Owner ship 2. Date Exercisable 3. Title and Amount of Securities Form of and Expiration Date Underlying Derivative Security 4. Conver- Derivative (Month/Day/Year) (Instr. 4) sion or Security: 6. Nature of ---------------------- --------------------------------- Exercise Direct Indirect Date Expira- Amount or Price of (D) or Beneficial 1. Title of Derivative Exer- tion Number of Derivative Indirect (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ n/a - ------------------------------------------------------------------------------------------------------------------------------------
/s/ Newton W. Jacobson 12/04/2001 - ------------------------------- ---------- **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).
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