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OMB APPROVAL
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- -------- OMB Number: 3235-0104
FORM 3 Expires: December 31, 2001
- -------- Estimated average burden
hours per response.... 0.5
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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
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<S> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Statement Trading Symbol of Original
Nierenberg, David (Month/Day/Year) Mexican Restaurants, Inc. (CASA) (Month/Day/Year)
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(Last) (First) (Middle) 2/14/00 5. Relationship of Reporting -----------------------
19605 N.E. 8th Street ---------------------------- Person(s) to Issuer 7. Individual or Joint/
- ---------------------------------------- 3. I.R.S. Identification (Check all applicable) Group Filing (Check
(Street) Number of Reporting X Director X 10% Owner Applicable Line)
Person, if an entity ----- ----- X Form filed by
Camas WA 98607 (voluntary) Officer Other (specify --- One Reporting
- -------------------------------------- ----- ----- below) Person
(City) (State) (Zip) ---------------------------- (give title below) Form filed by
--- More than One
------------------------------ Reporting Person
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Common Stock 670,300* I By D3 Family Fund, LP*
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Common Stock 25,000** I By The Nierenberg Family
1993 Trust**
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Common Stock 3,000*** I By Toxford Corporation***
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Common Stock 6,000*** I By James Henry
Hildebandt***
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Common Stock 28,000*** I By Haredale, Ltd.***
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* The Reporting Person is the sole shareholder of Nierenberg Investment Management Company, the General partner of the D3 Family
Fund, L.P.
** The Reporting Person is the trustee and a beneficiary of The Nierenberg Family 1993 Trust.
*** The Reporting Person is authorized to trade on behalf of these individuals/companies and receives financial compensation from
his trading.
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
*If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (3-99)
POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTIONS OF INFORMATION
CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS
A CURRENTLY VALID OMB CONTROL NUMBER.
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Explanation of Responses:
/s/ David Nierenberg 3/15/00
**Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- -------------
Violations. 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 is insufficient, See Instruction 6 for procedure. SEC 1473 (3-99)
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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.
