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OMB APPROVAL
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- ---------- OMB Number: 3235-0104
FORM 3 Expires: September 30, 1998
- ---------- Estimated average burden
hours per response .... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 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
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<S> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
LAGRANGE, ERIC Statement Trading Symbol of Original
- ------------------------------------------ (Month/Day/Year) Golf Ventures, Inc. (GVIM) (Month/Day/Year)
(Last) (First) (Middle) 11/25/97 ----------------------------------
255 South Orange Avenue, Ste. 1515 ---------------------------- 5. Relationship of Reporting -----------------------
- ------------------------------------------ 3. IRS Identification Person to Issuer 7. Individual or Joint/
(Street) Number of Reporting (Check all applicable) Group Filing (Check
Orlando, FL 32801 Person, if an Entity Director 10% Owner applicable line)
- ------------------------------------------ (Voluntary) ---- ---- X Form filed by
(City) (State) (Zip) ---------------------------- X Officer Other --- One Reporting
----(give title ----(specify Person
below) below) Form filed by
Chief Operating Officer --- More than One
----------------------------- Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Common Stock -0- -0- N/A
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Series D Convertible Preferred Stock -0- -0- N/A
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses) SEC 1473 (7/96)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Explanation of Responses:
/s/ ERIC LAGRANGE 12/8/97
**Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- -------------
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date
Note. File three copies of this Form, one of which must be manually signed. Page 2
If space provided is insufficient, See Instruction 6 for procedure. SEC 1473 (7/96)
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