FIFTH AVENUE ACQUISITION I CORP
5, 2001-01-19
NON-OPERATING ESTABLISHMENTS
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UNITED STATES SECURITIES AND EXCHANGE

COMMISSION

  

Washington, D.C. 20549

  

Form 5

ANNUAL STATEMENT OF CHANGES BENIFICIAL OWNERSHIP

   
__ Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1 (b).

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

X Form 3 Holdings Reported
__ Form 4 Transactions Reported
 
1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
X Director                                40% Owner
X Officer                                  ___ Other
(give title below)                     (specify below)

Richard Rubin

Fifth Avenue Acquisition I Corp.

                                    Secretary

730 Fifth Avenue, Suite 911

3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ###-##-####

4. Statement for Month/Year 12/2000

7. Individual or Joint/Group Filing
(Check Applicable)

New York, NY 10019

6. If Amendment, Date of Original (Month/Day/Year) N/A 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. Transaction Date

3. Transaction Code

4. Securities Acquired (A) or Disposed of (D)

5. Amount of Securities Beneficially Owned at the end of Issuer's Fiscal Year

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

7. Nature of Indirect Beneficial Ownership

Amount

(A) or (D)

Price

Common Stock

08/20/2000

P

400,000

A

$.001

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. Conversion or Exercise Price of Derivative Security

3. Transaction Date 4. Transaction Code 5. Number of Derivative Securities Acquired (A) or Disposed (D) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Security 8. Price of Derivative Security 9. Number of Derivative Securities Beneficially Owned at End of Year 10. Ownership of Derivative Security: Direct (D) or Indirect 11. Nature of Indirect Beneficial Ownership

(A)

(D)

Date Exercisable Expiration Title Amount or Number of Shares
                           
Explanation of Responses
  
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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