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FORM 4 Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b) |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 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 |
OMB APPROVAL |
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OMB Number: 3235-0287 |
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Expires: December 31, 2001 |
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Estimated average burden hours per response...0.5 |
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1. Name and Address of Reporting Person* COOLEY THOMAS E. (Last) (First) (Middle) 335 - 25 STREET S.E. (Street) CALGARY ALBERTA T2A 7H8 (City) (Province) (Postal Code) |
2. Issuer Name and Ticker or Trading Symbol Synergy Technologies Corporation ("OILS") |
6. Relationship of Reporting Person(s) to Issuer (Check all Applicable) _X__ Director ___ 10% Owner __X_ Officer ___ Other (Give Title Below) (Specify Below) Chief Executive Officer _____________________ |
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3. I.R.S. Identification Number of Reporting Person, If an entity (Voluntary)
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4. Statement for Month/Year August 2001 |
7. Individual or Joint/Group Reporting (Check Applicable Line) _X__ Form Filed by One Reporting Person ___ Form Filed by More than One Reporting Person |
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5. If Amendment, Date of Original (Month/Year)
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TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED |
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1. Title of Security (Instr. 3) |
2. Transaction Date (Month/Day/Year) |
3. Trans-action Code (Instr. 8) |
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned at End of Month (Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code |
V |
Amount |
(A) or (D) |
Price |
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Common Stock |
08/01/01 |
J* |
76,837 |
A |
$0.90 |
812,326 |
D |
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TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., puts calls warrants options, convertible securities) |
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1. Title of Derivative Security (Instr. 3) |
2. Con-version or Exercise Price of Derivative Security |
3. Transaction Date Month/Day /Year |
4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Deriv-ative Security (Instr. 5) |
9. Number of Deriv-ative Securities Beneficially Owned at End of Month (Instr. 4) |
10. Ownership Form of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code |
V |
(A) |
(D) |
Date Exer-cisable |
Expi-ration Date |
Title |
Amount or Number of Shares |
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Explanation of Responses: *THESE SHARES WERE ACQUIRED IN LIEU OF SALARY AND ISSUED TO THE REPORTING PERSON UNDER FORM S-8 FILED WITH THE SECURITIES AND EXCHANGE ON JULY 19, 2001 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 4(b)(v). ** 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. |
____________________________________ THOMAS E. COOLEY **Signature of Reporting Person |
September 17, 2001 Date |
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