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FORM 3 OMB APPROVAL
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OMB Number: 3235-0104
Expires: December 31, 2001
Estimated average burden
hours per response ....0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 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
Cape Cod Five Cents Savings Bank Statement Trading Symbol of Original
- ---------------------------------------- (Month/Day/Year) Falmouth Bancorp, Inc. FBC (Month/Day/Year)
(Last) (First) (Middle) 06/15/99 ---------------------------------- N/A
19 West Road, P.O. Box 10 ---------------------------- 5. Relationship of Reporting -----------------------
- ---------------------------------------- 3. IRS Identification Person to Issuer 7. Individual or Joint/
(Street) Number of Reporting (Check all applicable) Group Filing (Check
Orleans, MA 02653 Person, if an Entity Director X 10% Owner applicable line)
- ---------------------------------------- (Voluntary) ----- ----- X Form filed by
(City) (State) (Zip) 04-11490707 Officer Other ----- One Reporting
---------------------------- ----- (give ----- (specify Person
title below) below) Form filed by
----- More than One
---------------------------------- Reporting Person
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TABLE 1 -- 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. 4)
(Instr. 5)
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Common Stock, $0.01 par value 131,800 shares Direct N/A
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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).
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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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
Exercis- tion Title Number (I)
able Date of Shares (Instr.
5)
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Explanation of Responses:
/s/ Elliott G. Carr 6/24/99
**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
Elliott G. Carr, President
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.
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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