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FORM 3
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*
Jane Lewis
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(Last) (First) (Middle)
c/o Cay House
P.O. Box N7776
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(Street)
Lyford Cay, New Providence, Bahamas
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
12/16/99
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker of Trading Symbol
Dave & Busters, Inc./DAB
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5. Relationship of Reporting Person 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)
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7. Individual or Joint/Group Filing
(Check applicable line)
[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. 4)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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<S> <C> <C> <C>
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Common Stock 1,342,600 I by Mandarin, Inc.*
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
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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
or 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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Put (Obligation to buy) currently 2/2000 Common Stock 50,000 12.5 I by Mandarin,
exercisable Inc.*
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</TABLE>
Explanation of Responses:
*The securities reported herein are held by Mandarin, Inc. Joseph Lewis and
Jane Lewis are the shareholders and directors of Mandarin, Inc. This filing
shall not be deemed an admission that the Reporting Person is, for the purposes
of Section 16 of the Securities and Exchange Act or otherwise, the beneficial
owner of any securities covered by this statement.
** 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.
/s/ Jane Lewis 12/27/99
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** Signature of Reporting Person Date
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