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OMB APPROVAL
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------ OMB Number: 3235-0362
FORM 5 Expires: October 31, 2001
------ Estimated average burden
hours per response .... 1.0
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/ / Check box if no UNITED STATES SECURITIES AND EXCHANGE COMMISSION
longer subject to WASHINGTON, D.C. 20549
Section 16. Form
4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
obligations may
continue. See Filed pursuant to Section 16(a) of the Securities
Instruction 1(b) Exchange Act of 1934,
/X/ Form 3 Holdings Section 17(a) of the Public Utility
Reported Holding Company Act of 1935 or Section 30(f) of
/ / Form 4 the Investment Company Act
Transactions of 1940
Reported
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<S> <C> <C> <C> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer
Mitchell Thomas J. Infogrames, Inc. (IFGM)
--------------------------------------------------------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year Officer (give Other (specify
24 Tiberan Drive Person (Voluntary) 11/2000 ---- title --- below)
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(Street) 5. If Amendment, 7. Individual or Joint/Group Reporting
Date of Original (Check applicable line)
(Month/Year) X Form Filed by One Reporting
---- Person
Form Filed by More than One
Holmdale New Jersey 07733 ---- Reporting Person
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(City) (State) (Zip) TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Month/ (Instr. 8) end of Issuer's Direct Benefi-
Day/ Fiscal Year (D) or cial
Year) ---------------------------- (Instr. 3 and 4) Indirect Owner-
Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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No securities held
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(Over)
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C> <C> <C>
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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9. Number of 10. Ownership 11. Nature of
Derivative of Derivative Indirect
Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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Explanation of Responses:
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Thomas J. Mitchell 12/20/00
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- ---------
**Signature of Reporting Person Date
Note: File three copies of this Form, one of which must be manually signed. Page 2
If space provided is insufficient, see Instruction 6 for procedure. SEC 2270 (7-96)
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 currently valid OMB number.
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