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OMB APPROVAL
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-------------- OMB Number: 3235-0104
FORM 3 Expires: December 31, 2001
-------------- Estimated average burden
hours per form............ 0.5
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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
(Print or Type Responses)
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1. Name and Address of Reporting Person*
Queens County Bancorp, Inc.
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(Last) (First) (Middle)
38-25 Main Street
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(Street)
Flushing NY 11354
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
June 27, 2000
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3. IRS or Social Security Number of Reporting Person (Voluntary)
06-1377322
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4. Issuer Name AND Ticker or Trading Symbol
Haven Bancorp, Inc. HAVN
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[_] Director [X] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
________________________________________________________________________________
7. Individual or Joint/Group Filing (Check applicable line)
[X] Form Filed by One Reporting Person
[_] Form Filed by More than One Reporting Person
<PAGE>
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5)
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<S> <C> <C> <C>
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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 Reporting Person, see Instruction
5(b)(v).
(Over)
SEC 1473 (3-99)
<PAGE>
FORM 3 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Option to purchase (T) (T) Haven Bancorp, Inc. 1,800,000 (TT) D
Haven Bancorp, Inc. Common Stock
Common Stock
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<FN>
Explanation of Responses:
(T) Beneficial ownership of 1,800,000 shares reported hereunder is being reported solely as a result of the Stock Option
Agreement, dated as of June 27, 2000 (the "Stock Option Agreement"), by and between Queens County Bancorp, Inc. and Haven
Bancorp, Inc. The option may be exercised, in whole or in part, only upon certain events (none of which, as of the date
hereof, has occurred), as set forth in the Stock Option Agreement. The option expires upon certain events, as set forth in
the Stock Option Agreement. The option granted pursuant to the Stock Option Agreement has not yet become exercisable. Queens
County Bancorp, Inc. expressly disclaims ownership of such shares.
(TT) A price per share equal to $18.0625, subject to adjustment under certain circumstances.
</FN>
</TABLE>
<TABLE>
<S> <C> <C>
** Intentional misstatements or omissions of /s/ Joseph R. Ficalora July 6, 2000
facts constitute Federal Criminal Violations. ----------------------------------------- ----------------
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Joseph R. Ficarola, Chairman, President Date
and Chief Executive Officer on behalf of
Queens County Bancorp, Inc.
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
</TABLE>
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SEC 1473 (3-99)
