<TABLE>
- ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------
FORM 3 Washington, D.C. 20549 OMB Approval
- ------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES ------------------------------
OMB Number: 3235-0104
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Expires: December 31, 2001
Section 17(a) of the Public Utility Holding Company Act of 1935 or Estimated average burden
Section 30(f) of the Investment Company Act of 1940 hours per response.......0.5
------------------------------
<CAPTION>
(Print or Type Responses)
- ------------------------------------------------------------------------------------------------------------------------------------
1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer name and Ticker or Trading Symbol
Statement (Month/Day/Year)
November 22, 1999 Official Payments Corporation, OPAY
Stern, Kenneth -----------------------------------------------------------------------------------------
------------------------------------ 3. I.R.S. Identification 5. Relationship of Reporting 6. If Amendment, Date of
(Last) (First) (Middle) Number of Reporting Person(s) to Issuer Original
Person, if an entity (Check all applicable) (Month/day/Year)
2333 San Ramon Valley Boulevard (Voluntary)
Suite 450 [X] Director
------------------------------------ [X] Officer ----------------------------
(Street) (give title below) 7. Individual or Joint/Group
[X] 10% Owner Filing
[ ] Other (Check Applicable Line)
San Ramon CA 94583 (specify below) [X] Form Filed by One
------------------------------------ Reporting Person
(City) (State) (Zip) President [ ] Form Filed by More
------------------------- than One Reporting
Person
- ------------------------------------------------------------------------------------------------------------------------------------
TABLE I NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
<S> <C> <C> <C>
- ------------------------------------------------------------------------------------------------------------------------------------
1. Title of Security 2. Amount of Securities 3. Ownership Form: Direct (D) 4. Nature of Indirect
(Instr. 4) Beneficially Owned or Indirect (I) (Instr. 5) Beneficial Ownership
(Instr. 4) (Instr. 5)
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock, par value $0.01 3,000,000 I By corporation
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
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
Page 1 of 2
SEC 1473 (3-99)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
FORM 3 (CONTINUED)
TABLE II-- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
- ------------------------------------------------------------------------------------------------------------------------------------
1. Title of 2. Date Exer- 3. Title and Amount of 4. Conversion or 5. Ownership 6. Nature of
Derivative cisable and Securities Underlying Exercise Price Form of Indirect
Security Expiration Derivative Security of Derivative Derivative Beneficial
(Instr. 4) Date (Instr. 4) Security Security: Ownership
(Month/Day/Year) Direct (D) or (Instr. 5)
Indirect (I)
(Instr. 5)
- ------------------------------------------------------------------------------------------------------------------------------------
Date Expira- Title Amount or
Exer- tion Number of
cisable Date Shares
- ------------------------------------------------------------------------------------------------------------------------------------
Employee Stock Option Immed. 8/30/09 Common Stock, 171,429 $1.33 D
(right to buy) (1) par value $0.01
- ------------------------------------------------------------------------------------------------------------------------------------
Employee Stock Option Immed. 9/29/09 Common Stock, 40,644 $1.33 D
(right to buy) (1)
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
(1) The option vests immediately on the date of the initial public offering, or November 29, 1999.
** 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 /s/ Kenneth Stern 12/8/99
signed. If space is insufficient, see Instruction 6 for ------------------------------------ -------------------
procedure. ** Signature of Reporting Person Date
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.
Page 2 of 2
SEC 1473 (3-99)
</TABLE>
