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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 |
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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* Haworth Cameron (Last) (First) (Middle) c/o 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) President _____________________ |
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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 February/2000 March/2000 |
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 |
February 23, 2001 |
M |
4,500 |
A |
$1.00 |
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Common Stock |
March 19, 2001 |
M |
1,000 |
A |
$1.00 |
12,500 |
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 Derivative Security (Instr. 5) |
9. Number of Derivative 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 |
Amt or No of Shares |
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Options for Common Stock |
February 23, 2001 |
M |
D |
2/18/00 |
2/18/10 |
Com-mon Shares |
4,500 |
0 |
D |
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Options for Common Stock |
March 19, 2001 |
M |
D |
2/18/00 |
2/18/10 |
Com-mon Shares |
1,000 |
0 |
244,500(1) |
D |
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Explanation of Responses:
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. |
/S/ CAMERON HAWORTH **Signature of Reporting Person |
April 3, 2001 Date |
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(1) As of March 19, 2001