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OMB APPROVAL
[X] Check this box if no longer ------------------------------
subject to Section 16. Form 4 or OMB Number 3235-0287
Form 5 obligations may continue. Expires: 12-31-2001
See Instruction 1(b). Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
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*
CHAVEZ CHARLES
________________________________________________________________________________
(Last) (First) (Middle)
15423 East Batavia Drive
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(Street)
Aurora CA 80011
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(City) (State) (Zip)
________________________________________________________________________________
2. Issuer Name and Ticker or Trading Symbol
IN STORE MEDIA SYSTEMS, INC./ ISMS
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
________________________________________________________________________________
4. Statement for Month/Year
________________________________________________________________________________
5. If Amendment, Date of Original (Month/Year)
10/99
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[_] Officer (give title below) [X] Other (specify below)
Resigned April 11, 2000
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________________________________________________________________________________
7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by One Reporting Person
[_] Form filed by more than One Reporting Person
________________________________________________________________________________
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock ($.001 par value) (1) 403,500(2) D
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Common Stock ($.001 par value) (1) 615,375(2) II Owned by
members of
members of
family;
reporting
person
disclaims
beneficial
ownership.
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction
4(b)(v).
(Over)
SEC 1474(3-99)
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FORM 4 (continued)
Table II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Explanation of Responses:
(1) Reporting person resigned as an Officer and Director of the Company on
April 11, 2000.
(2) Shares reported on initial reporting person's Form 3 dated 10/15/99
have been adjusted to correctly report shares owned Directly and
Indirectly according to the records of the Company's transfer agent.
/S/ Charles Chavez September 18, 2000
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**Signature of Reporting Person Date
CHARLES CHAVEZ
** 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 provided is insufficient, see Instruction 6 for procedure.
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