PROACTIVE TECHNOLOGIES INC
3, 1999-01-19
MEDICAL LABORATORIES
Previous: PROACTIVE TECHNOLOGIES INC, 8-K, 1999-01-19
Next: PROACTIVE TECHNOLOGIES INC, SC 13D, 1999-01-19



<PAGE>
 
                                   --------
                                    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
- ------------------------------------------------------------------------------
1. Name and Address of Reporting Person*
 
    Lance Children's Trust
    --------------------------------------------------------------------------
    (Last)                            (First)                            (MI)
 
    3821 Stratford Road, N.E.
    --------------------------------------------------------------------------
                                   (Street)
 
    Atlanta                          Georgia                           30342
    --------------------------------------------------------------------------
    (City)                           (State)                           (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
                   1/8/99
- ------------------------------------------------------------------------------
3. IRS or Social Security Number of Reporting Person (Voluntary)

- ------------------------------------------------------------------------------
4. Issuer Name and Ticker or Trading Symbol

   Proactive Technologies,Inc.  (PTE)
- ------------------------------------------------------------------------------
5. Relationship of Reporting Person to Issuer (Check all applicable)

   [   ]  Director                       [ X ]  10% Owner
   [   ]  Officer (give title below)     [   ]  Other (specify below)

- ------------------------------------------------------------------------------
6. If Amendment, Date of Original (Month/Day/Year)

- ------------------------------------------------------------------------------
7. Individual or Joint/Group Filing (Check Applicable Box)
   [ X ] Form filed by One Reporting Person
   [   ] Form filed by More than One Reporting Person
<PAGE>
 
TABLE I - Non-Derivative Securities Beneficially Owned
- ------------------------------------------------------------------------------

- ------------------------------------------------------------------------------
1. Title of   |  2. Amount of Securities  | 3. Ownership Form: | 4. Nature of
   Security   |     Beneficially Owned    |    Direct (D) or   |    Indirect
   (Instr. 4) |     (Instr. 4)            |    Indirect (I)    |    Beneficial
              |                           |    (Instr. 5)      |    Ownership
- ------------------------------------------------------------------------------
Common Stock  |     3,600,000 shares      |          D         |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------
              |                           |                    |
- ------------------------------------------------------------------------------

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)(iv).
                     (Print or Type Responses)
                                                         (Over)


FORM 3 (continued)
                  Table II -- Derivative Securities Beneficially Owned
                  (e.g., puts, calls, warrants, options, convertible securities)
- --------------------------------------------------------------------------------
1. Title of Derivative      | 2. Date Exercisable and Expiration Date
   Security (Instr. 4)      |    (Month/Day/Year)
                            |---------------------------------------------------
                            |     Date Exercisable     |    Expiration Date
- --------------------------------------------------------------------------------
a)                          |                          |
                            |                          |
- --------------------------------------------------------------------------------
b)                          |                          |
                            |                          |
- --------------------------------------------------------------------------------
c)                          |                          |
                            |                          |
- --------------------------------------------------------------------------------
d)                          |                          |
                            |                          |
================================================================================
<PAGE>
 
- -------------------------------------------------------------------------------
3. Title and Amount of   | 4. Conversion or  | 5. Ownership   | 6. Nature of
   Securities Underlying |    Exercise Price |    Form of     |    Indirect
   Derivative Security   |    of Derivative  |    Derivative  |    Beneficial
   (Instr. 4)            |    Security       |    Security:   |    Ownership
- -------------------------|                   |    Direct (D)  |    (Instr. 5)
            | Amount of  |                   |    or          |
            | Number of  |                   |    Indirect (I)|
  Title     | Shares     |                   |    (Instr. 5)  |
- --------------------------------------------------------------------------------
            |            |                   |                |
a)          |            |                   |                |
            |            |                   |                |
- --------------------------------------------------------------------------------
            |            |                   |                |
b)          |            |                   |                |
            |            |                   |                |
- --------------------------------------------------------------------------------
            |            |                   |                |
c)          |            |                   |                |
            |            |                   |                |
- --------------------------------------------------------------------------------
            |            |                   |                |
d)          |            |                   |                |
            |            |                   |                |
- --------------------------------------------------------------------------------

Explanation of Responses: The filing of this Statement shall not be construed as
an admission (a) that the person filing this Statement is, for the purposes of
Section 16 of the Securities Exchange Act of 1934 (as amended), the beneficial
owner of any equity securities covered by this Statement, or (b) that this
Statement is legally required to be filed by such 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.

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 Number.

     /s/ C. Beverly Lance, Trustee                         January 14, 1999
- -----------------------------------------                 ------------------
    **Signature of Reporting Person                              Date

                                                                          Page 2


© 2022 IncJournal is not affiliated with or endorsed by the U.S. Securities and Exchange Commission