FORM 4 |
[ ] Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
1. Name and Address of Reporting Person
Richard D. Surber (Last) (First) (Middle) |
2. Issuer Name and Ticker or Trading Symbol
Kelly's Coffee Group, Inc. OTC-Bulletin Board Symbol =KLYS
|
6. Relationship of Reporting Person to Issuer
X Director X 10% Owner X Officer (give title below) X Other (specify below) Surber owns and has beneficial ownership of approximately 28% of outstanding shares (as president of companies owning said shares). Surber is President and Director of Issuer. | |
268 West 400 South - Suite 300 (Street) |
3. IRS or Social Security Number of Reporting Person (Voluntary) |
4. Statement for Month/Year March, 2001 |
|
Salt Lake City Utah 84101 (City) (State) (Zip) |
5. If Amendment,
Date of Original (Month/Year) |
||
1. Title of Security
(Instr. 3) |
2. Transaction Date
(Month/Day/Year) |
3. Transaction
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) | |||
Code |
V |
Amount |
(A) or
(D) |
Price |
|||||
Common Stock | Mar. 6, 2001 | S | 85,000 | D | $0.05 | 14,457,540 | D | ||
Common Stock | Mar. 19, 2001 | S | 90,000 | D | $0.03 | 14,457,540 | D | ||
Common Stock | Mar. 27, 2001 | S | 200,000 | D | $0.045 | 14,457,540 | D | ||
Common Stock | Mar. 28, 2001 | S | 100,000 | D | $0.045 | 14,457,540 | D | ||
Common Stock | Mar. 29, 2001 | S | 127,800 | D | $0.045 | 14,457,540 | D |
FORM 4 (continued)
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security |
3. Transaction Date (Month/ Day/Year) |
4. Trans-action Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4,& 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 Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
10.Owner-ship Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature
of
Indirect
Beneficial Owner-ship (Instr. 4) | ||||
|
V |
|
|
Date Exer-cisable |
Expir-ation Date |
|
Amt.. or No. of Shares |
|||||||
Explanation of Responses:
** Intention misstatements or omission of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a)
/s/ Richard D. Surber
Richard D. Surber
Date: April 16, 2001
Note: File three copies of this Form, one of which must be manually signed. If space
provided is insufficient, See Instruction 6 for procedure.
Page 2
SEC 1474 (8-92)