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OMB APPROVAL
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- -------- OMB Number: 3235-0104
FORM 3 Expires: September 30, 1998
- -------- 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
Record Michael D. (Month/Day/Year) PawnMart, Inc. (PMRT) (Month/Day/Year)
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(Last) (First) (Middle) 9/8/98 5. Relationship of Reporting -----------------------
301 Commerce Street Suite 3600 ---------------------------- Person(s) to Issuer 7. Individual or Joint/
- ---------------------------------------- 3. I.R.S. Identification (Check all applicable) Group Filing (Check
(Street) Number of Reporting Director 10% Owner Applicable Line)
Person, if an entity ----- ----- X Form filed by
Fort Worth Texas 76102 (voluntary) X Officer Other (specify --- One Reporting
- -------------------------------------- ----- ----- below) Person
(City) (State) (Zip) ---------------------------- (give title below) Form filed by
President --- 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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None
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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). SEC 1473 (3-99)
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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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Employee Option, Right to Buy 9/8/98 9/8/08 Common Stock 33,300 $3.00 D
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Employee Option, Right to Buy 9/8/99 9/8/08 Common Stock 22,925 $3.00 D
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Employee Option, Right to Buy 9/8/00 9/8/08 Common Stock 22,925 $3.00 D
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Employee Option, Right to Buy 9/8/01 9/8/08 Common Stock 22,925 $3.00 D
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Employee Option, Right to Buy 9/8/02 9/8/08 Common Stock 22,925 $3.00 D
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Explanation of Responses: Amounts previously reported on Form 3 filed 10/16/98 included an inadvertent misstatement in Mr. Record's
vesting schedule of employee stock options.
/s/ Michael D. Record 5/3/99
**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
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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