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UNITED STATES SECURITIES AND EXCHANGE COMMISSION |
OMB APPROVAL Expires: October 31, 2001 Estimated average burden hours per response ...0.5 |
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1. Name and Address of Reporting Person* Haller, Ralph A. |
2. Date of Event Requiring Statement 5/11/00 |
4. Issuer Name and Ticker or Trading Symbol US Data Authority, Inc. |
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(Last) (First) (Middle) 122 Baltimore Street |
5. Relationship of Reporting Person(s) to Issuer (Check all applicable) ___X_ Director _____ 10% Owner |
6. If Amendment, Date of Original (Month/Day/Year) |
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(Street) |
3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) |
7. Individual of Joint/Group Filing (Check Applicable Law) ___ Form filed by More than One Reporting Person |
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(City) (State) (Zip) |
Table I - Non-Derivative Securities Beneficially owned |
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1. Title of Security |
2. Amount of Securities Beneficially Owned |
3. Ownership |
4. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Common stock, $.02 par value |
25,000 |
D |
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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 5(b)(v).
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 control number
Form 3 (continued) Tale II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security |
2. Date Exer- |
3. Title and amount of Securities Underlying Derivative Security |
4. Conver- |
5. Owner-ship Form of Derivative Security: Direct (D) or Indirect (I) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exer-cisable |
Expira-tion Date |
Title |
Amount or |
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Explanation of Responses:
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /S/ Ralph A. Haller 11/28/00
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. 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 currently valid OMB Number.
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