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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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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
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1. Name and Address of Reporting Person
Lonergan Edmond L
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(Last) (First) (Middle)
c/o Corporate Architects, Inc.
10245 East Via Linda, Suite 220
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(Street)
Scottsdale, AZ 85258
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
August 21, 2000 (Date form 10 will become effective)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
86-095173
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4. Issuer Name and Ticker or Trading Symbol
Fifthcai, Inc. The company does not trade.
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
President
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6. If Amendment, Date of Original (Month/Year)
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7. Individual or Joint/Group Filing (Check Applicable Line)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
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<PAGE>
FORM 3 (continued)
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Table I -- Non-Derivative Securities Beneficially Owned
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3. Ownership Form:
1. Title of 2. Amount of Securities Direct (D) or 4. Nature of Indirect
Security Beneficially Owned Indirect (I) Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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Common Stock 5,000,000 D N/A
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<CAPTION>
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3. Title and Amount 5. Owner-
of Securities Underlying ship
Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date ------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
1. Title of ---------------------- or Exercise (D) or Indirect
Derivative Date Expira- Number Price of Indirect Beneficial
Security Exer- tion of Derivative (I) Ownership
(Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
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Explanation of Responses:
/s/ Edmond L. Lonergan August 11, 2000
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Edmond L. Lonergan, President Date
**Signature of Reporting Person
** 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.
If space provided is insufficient. See Instruction 6 for procedure.
