|
FORM 3
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 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 |
OMB APPROVAL |
||||||||||||||
|
OMB NUBMER: 3235-0104 |
||||||||||||||||
|
Expires: December 31, 2001 |
||||||||||||||||
|
Estimated average burden hours per response...0.5 |
||||||||||||||||
|
1. Name and Address of Reporting Person* Coffey Barry (Last) (First) (Middle) 4321 Park Avenue South, 12 Floor (Street) New York New York 10016 (City) (State) (Zip Code) |
2. Date of Event Requiring Statement (Month/Day/Year) January 16, 2001 |
4. Issuer Name and Ticker or Trading Symbol Synergy Technologies Corporation "OILS" |
||||||||||||||
|
3. I.R.S. Identification Number of Reporting Person, If an entity (Voluntary)
|
5. Relationship of Reporting Person(s) to Issuer (Check all Applicable) X Director ___ 10% Owner ___ Officer ___ Other (Give Title Below) (Specify Below) ______________ ___________ |
6. If Amendment, Date of Original (Month/Day/Year) |
||||||||||||||
|
7. Individual or Joint/Group Filing (Check Applicable Line) X Form Filed by One Reporting Person ___ Form Filed by More than One Reporting Person |
||||||||||||||||
|
TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED |
||||||||||||||||
|
1. Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned (Instr. 4) |
3. Ownership form: Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership (Instr. 5) |
|||||||||||||
|
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts calls warrants options, convertible securities) |
||||||||||||||||
|
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Securities: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
|||||||||||
|
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|||||||||||||
|
Options to purchase Shares of Common Stock |
01/16/01 |
01/16/11 |
Common Shares |
200,000 |
$1.50 |
D |
||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly Explanation of Responses:
*If the form is filed by more than one reporting person, see Instruction 5(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/ Barry Coffey **Signature of Reporting Person |
May 11, 2001 Date |
||||||||||||||