FORM 3 U.S. 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
1. Name and Address 2. Date of Event Requiring 4. Issuer Name and Ticker
of Reporting Person* Statement for or Trading Symbol
(Month/Day/Year)
HERMAN DEREK . JANUARY 18, 2000 QUILCHENA RESOURCES INC.
- ------------------------ ---------------------- ------------------------
(Last) (First) (Middle)
302 - 825 West 8th Avenue 3. IRS or Social 5. Relationship 6. If Amendment,
- ------------------------ Security Number of of Reporting Date of
(Street) Reporting Person Person to Original
(Voluntary) Issuer (Month/Day/
Year)
Vancouver, BC V5Z 1E3 [X]Director -
- ------------------------ ----------------- [X]Officer
(City) (State) (Zip) (give title below)
[ ] 10% Owner
PRESIDENT
* If the Form is filed -----------------------
by more than one Reporting 7. Individual or Joint/Group Filing
Person, see Instructions (Check applicable line)
5(b)(v) [X] Form filed by One Reporting
-------------------------- Person
[ ] Form filed by More than One
Reporting Person
---------------------------------
TABLE I - NON-DERIVATIVE SERVICES BENEFICIALLY OWNED
---------------------------------------------------------
<TABLE>
<CAPTION>
1. Title of Security 2. Amount of Securities 3. Ownership From: 4. Nature of Indirect Beneficial Ownership
(Instr. 4) Beneficially Owned Direct (D) or (Instr. 5)
(Instr. 4) Indirect (I)
(Instr. 5)
- ------------------------- ------------------- ------------ --------------------------------------------
<S> <C> <C> <C>
Common Shares 1,000 D
497,500 I Spirit Investment Inc.
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Over)
(Print or Type Response)
<PAGE>
FORM 3 (continued)
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
1. Title of 2. Date Exercisable 3. Title and Amount 4. Conversion 5. Ownership 6. Nature of
Derivative and Expiration of Securities or Exercise Form of Indirect
Security Date (Month/Day Underlying Price of Derivative Beneficial
(Instr. 4) Year) Derivative Derivative Security: Ownership
Security Security Direct (D) (Instr. 5)
(Instr. 4) or Indirect (I)
Date Expiration Title Amount or
Exercis- Date Number of
able Shares
- ------------- ---------------------- -------------------- ------------- -------------- ---------------
<S> <C> <C> <C> <C> <C> <C> <C>
- - - - - - - - -
</TABLE>
Explanation of Responses:
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a)
/s/ Derek Herman February 10, 2000
------------------- ----------------
. **Signature of Reporting Person Date
Note: File three copies of this Form, one of which must be manually signed. If
space provided is insufficient,
See Instruction 6 for procedure.
