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FORM 3 OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response 0.5
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UNITED STATES 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
(Print or Type Responses)
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1. Name and Address of Reporting Person
Brehm Jack
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(Last) (First) (Middle)
1930 Village Center Drive, Suite 3-183
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(Street)
Summerlin Nevada 89134-1389
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
02/01/00
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker of Trading Symbol
Gamogen, Inc. (GAMO)
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ ] Director
[ ] 10% Owner
[X] Officer (give title below)
[ ] Other (specify below)
Chief Financial Officer
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing
(Check all applicable)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
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FORM 3 (continued)
<TABLE>
<CAPTION>
TABLE I--Non-Derivative Securities Beneficially Owned
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Onwership
(Instr. 4) Beneficially Owned Form: Direct (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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<S> <C> <C> <C>
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common stock 10,000 (I) By Jack Brehm & Gilda Brehm
Trust AU DTD Dec 3, 1985
Jack Brehm & Gilda Brehm
Family Trust
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</TABLE>
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 person, see Instruction 5(b)(v).
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FORM 3 (continued)
<TABLE>
<CAPTION>
TABLE II--Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of
Security (Instr. 4) cisable and Underlying Derivative Security sion or ship Indirect
Expiration (Instr. 4) Exercise Form of Beneficial
Date ----------------------------------- Price of Deriv- Ownership
(Month/Day/Year) Deriv- ative (Instr. 5)
--------------------- Amount ative Security
of Security Direct
Date Expira- Title Number (D) or
Exer- tion of Indirect
cisable Date Shares (I)
(Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Explanation of Responses:
/s/ Jack Brehm 02/10/00
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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 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.
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