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FORM 4
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OMB APPROVAL
[ ] Check this box if no longer subject ----------------------------------
to Section 16. Form 4 or Form 5 OMB Number: 3235-0287
obligations may continue. See Expires: April 30, 1997
Instruction 1(b). Estimated average burden
hours per response....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
Lewis Jane
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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. Issuer Name and Ticker or Trading Symbol
Dave & Busters, Inc. (DAB)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
12/1999
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5. If Amendment, Date of Original (Month/Year)
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6. 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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<TABLE>
<CAPTION>
TABLE I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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5. Amount of 6. Owner-
Securities ship
2. Trans- 3. Trans- 4. Securities Acquired (A) Beneficially Form:
action action or Disposed of (D) Owned at Direct 7. Nature of
Date Code (Instr. 3, 4 and 5) End of (D) or Indirect
1. Title of Security (Month/ (Instr. 8) -------------------------- Month Indirect Beneficial
(Instr. 3) Day/ ---------- Amount (A) or Price (Instr. (I) Ownership
Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 12/20/99 P 29,500 A $6.1928 1,372,100 I (1)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (over)
</TABLE>
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FORM 4 (continued)
<TABLE>
<CAPTION>
TABLE II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g. puts, calls, warrants, options, convertible securities)
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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
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Title and Ownership
Number of Date Exer- Amount of Form of
Derivative cisable and Underlying Number of Deriv-
Securities Expiration Securities Price Derivative ative
Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security:
sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct
Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of
Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect
Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial
Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership
(Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Put Options $5 12/21/99 S 300 (2) 5/2000 Common 30,000 7/8 300 I (1)
(Obligation Stock
to buy)
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Put 12.5 500 (2) 2/00 Common 50,000 500 I (1)
(Obligation Stock
to buy)(3)
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</TABLE>
Explanation of Responses:
(1) 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 Exchange Act of 1934 or
otherwise, the beneficial owner of any securities covered by this
statement. The entire amount of Mandarin, Inc.'s holdings is reported
herein.
(2) Currently exercisable.
(3) Previously reported.
/s/ Jane Lewis 1/7/00
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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 provided is insufficient, see Instruction 6 for procedure.
