US DATA AUTHORITY INC
3, 2000-12-04
HOTELS & MOTELS
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FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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 of Section 30(f) of the Investment Company Act of 1940

 

1. Name and Address of Reporting Person*

Haller, Ralph A.

2. Date of Event Requiring Statement
(Month/Day/Year)

5/11/00

4. Issuer Name and Ticker or Trading Symbol

US Data Authority, Inc.

(Last) (First) (Middle)

122 Baltimore Street

5. Relationship of Reporting Person(s) to Issuer

(Check all applicable)

___X_ Director _____ 10% Owner
_____ Officer (give _____ Other (Specify
title below) below)
_______________________________

6. If Amendment, Date of Original (Month/Day/Year)

(Street)

Gettysburg PA 17325

3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)

7. Individual of Joint/Group Filing (Check Applicable Law)
_x_ Form filed by One Reporting Person
___ Form filed by More than One
Reporting Person

(City) (State) (Zip)

Table I - Non-Derivative Securities Beneficially owned

1. Title of Security
(Instr. 4)

2. Amount of Securities Beneficially Owned
(Instr. 4)

3. Ownership
Form: Direct
(D) or Indirect
(I) (Instr. 5)

4. Nature of Indirect Beneficial Ownership (Instr. 5)

Common stock, $.02 par value

25,000

D

 
       
       
       
       
       
       
       
       
       
       
       

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
(Instr. 4)

2. Date Exer-
cisable and
Expiration Date
(Month/Day/Year)

3. Title and amount of Securities Underlying Derivative Security
(Instr. 4)

4. Conver-
sion or Exercise
Price of Derivative
Security

5. Owner-ship Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)

6. Nature of Indirect Beneficial Ownership (Instr. 5)

Date Exer-cisable

Expira-tion Date

Title

Amount or
Number of
Shares

               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               

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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