FIFTH AVENUE ACQUISITION I CORP
3, 2001-01-19
NON-OPERATING ESTABLISHMENTS
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UNITED STATES SECURITIES AND EXCHANGE

 

COMMISSION

 
 

Washington, D.C. 20549

     
     
 

Form 3

INITIAL STATEMENT OF BENIFICIAL 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 of Reporting Person* 2. Date of Event Required Statement (Month/Day/year) 4. Issuer Name and Ticker or Trading Symbol
Richard Rubin

12/12/2000

Fifth Avenue Acquisition I Corp.

 

730 Fifth Avenue, Suite 911

3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ###-##-#### 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) 6. If Amendment, Date of Original (Month/Day/Year)

N/A

X Director              40% Owner
X Officer                ___ Other
(give title below    (specify below)
 

New York, NY 10019

 

 

Secretary

7. Individual or Joint/Group Filing (Check Applicable)
X Form filed by One
__ Form filed by More than One Reporting person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security

2. Amount of Securities Beneficially Owned

3. Ownership Form: Direct (D) or Indirect (I)

4. Nature of Indirect Beneficial Ownership

Common Stock

400,000

D

N/A

       

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, and convertible securities)

1. Title of Derivative Security 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Securities: Direct (D) or Indirect (I) 6. Nature of Indirect Beneficial Ownership
Date Exercisable Expiration Date Title Amount or Number of Shares
               
               
               

By /s/ Richard Rubin, January 18, 2001

** Signature of reporting Person Date
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 4(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

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