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OMB APPROVAL
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OMB Number 3235-0287
Expires: 12-31-2001
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
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*
TESSLER ALLAN R.
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(Last) (First) (Middle)
8750 N. Central Expressway, #600
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(Street)
Dallas TX 75231
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(City) (State) (Zip)
JACKPOT ENTERPRISES, INC. (J)
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2. Issuer Name and Ticker or Trading Symbol
###-##-####
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
DECEMBER 2000
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4. Statement for Month/Year
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
CHAIRMAN OF THE BOARD
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by 1 Reporting Person
[_] Form filed by more than 1 Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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COMMON STOCK PAR VALUE $.01 12/06/00 51,659 A $6.00 51,659 I ART-FGT
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Family
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Partners Ltd
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COMMON STOCK PAR VALUE $.01 197,298 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
(Over)
SEC 1474(3-99)
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FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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Option to Buy $10.00 9/30/96 6/30/01 Common 27,500 27,500 D
Common Stock Stock
Par Value
$.01
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Option to Buy $11.50 9/30/97 6/30/02 Common 27,500 27,500 D
Common Stock Stock
Par Value
$.01
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Option to Buy $9.9375 9/30/98 6/30/03 Common 27,500 27,500 D
Common Stock Stock
Par Value
$.01
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Option to Buy $8.75 9/30/99 6/30/04 Common 27,500 27,500 D
Common Stock Stock
Par Value
$.01
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Option to Buy $9.00 9/14/00 9/14/09 Common 15,000 15,000 D
Common Stock Stock
Par Value
$.01
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Option to Buy $9.00 9/14/01 9/14/09 Common 15,000 15,000 D
Common Stock Stock
Par Value
$.01
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Convertible $10.75 6/01/01 3/31/07 Common 93,023 93,023 D
Debt Stock
Par Value
$.01
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Convertible $10.75 6/01/01 3/31/07 Common 186,047 186,047 I ZBBF-J
Debt Stock Net
Par Value Enterprises
$.01
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Option to Buy $ 9.50 9/29/00 A 09/29/00 6/30/05 Common 27,500 27,500 D
Stock
Par Value
$.01
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</TABLE>
Explanation of Responses:
/s/ Allan R. Tessler 01/10/01
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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.
If space provided is insufficient, see Instruction 6 for procedure.
