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FORM 3 OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
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
Cordova Denise E. Statement Trading Symbol of Original
- ---------------------------------------- (Month/Day/Year) EBONY & GOLD VENTURES, INC. (Month/Day/Year)
(Last) (First) (Middle) October 2, 1999 ----------------------------------
17817 San Rafael St. ---------------------------- 5. Relationship of Reporting -----------------------
- ---------------------------------------- 3. IRS or Social Security Person to Issuer 7. Individual or Joint/
(Street) Number of Reporting (Check all applicable) Group Filing (Check
Fountain Valley, CA 92708 Person (Voluntary) X Director X 10% Owner applicable line)
- -------------------------------------- ----- ----- X Form filed by
(City) (State) (Zip) ---------------------------- X 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 $.001 500,000 D
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*If the form is filed by more than one Reporting Person, see Instruction 5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses) (8/96)
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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) Deriv- ative
ative Security:
Security
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Date Expira- Amount or (D) or
Exercis- tion Title Number Indirect (I)
able Date of Shares (Instr. 5)
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WARRANT
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Explanation of Responses:
See the description under the heading "Joint Filer Information" BY:
in the Form 3 Continuation Sheet attached hereto. /s/ DENISE E. CORDOVA October 20, 1999
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**Signature of Reporting Person Date
**Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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. (8/96)
Potential persons who are to respond to the collection of information contained in this form
are not to respond unless the form displays a currently value OMB Number.
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