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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-C
REPORT BY ISSUER OF SECURITIES QUOTED ON NASDAQ INTERDEALER QUOTATION SYSTEM
Filed pursuant to Section 13 or 15(d) of the
Securities Exchange Act of 1934 under rule 13a-17
or 15(d)-17 thereunder
JAVA CENTRALE, INC.
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(Exact name of issuer as specified in charter)
1610 Arden Way, Suite 145
Sacramento, California 95815
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(Address of principal executive offices)
ISSUER'S TELEPHONE NUMBER, INCLUDING AREA CODE: (916) 568-2310
I. CHANGE IN NUMBER OF SHARES OUTSTANDING
1. Title of security: Common Stock, no par value
2. Number of shares outstanding before the change: 10,778,003
3. Number of shares outstanding after the change: 11,363,781
4. Effective date of change: September 18, 1996
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5. Method of change: Additional shares were issued in four previous
transactions.
(a) On August 2, 1996, 18,652 common shares were issued a result of
a partial conversion of the convertible note dated December 14, 1995
with Gross Foundation.;
(b) On August 2, 1996, 159,335 common shares were issued as a result of a
partial conversion of a convertible note dated January 29, 1996 with
Santina Holding, Inc.;
(c) On August 15, 1996, 157,791 common shares were issued as a result of
a partial conversion convertible note dated December 14, 1996 with
Legong Investments N.V.;
(d) On September 12, 1996, 250,000 common shares were issued as a result
of a warrant dividends being exercised.
II. CHANGE IN NAME OF ISSUER
1. Name prior to change: N/A
2. Name after change: N/A
3. Effective date of charter amendment change name: N/A
4. Date of shareholder approval of change, if required: N/A
Date: September 18, 1996
JAVA CENTRALE, INC.
By: /s/ Steven J. Orlando
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Steven J. Orlando
Vice President and
Chief Financial Officer
(Officer's signature and title)
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