Form 3
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 3

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(h) of the Investment Company Act of 1940


1. Name and Address of Reporting
Person*
2. Date of Event Requiring Statement
(Month/Day/Year)
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Carbone, Anthony J.
(Last) (First) (Middle)
  3/11/2003
 
 
 
     
  311 Belle Foret Drive
Suite 150

(Street)
4. Issuer Name and Ticker or Trading Symbol 5. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
    Patron Holdings, Inc.; PAHG
  x  Director o  10% Owner
      o  Officer (give title below)
    6. If Amendment, Date of Original
(Month/Day/Year)
  o  Other (specify below)
  Lake Bluff, IL 60044
(City)         (State)         (Zip)
 

   
      7. Individual or Joint/Group Filing
(Check Applicable Line)
        x Form Filed by One Reporting Person
                o Form Filed by More than One Reporting Person

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 5(b)(v).


 


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)

           

           

           

           

           

           

           

           

           

           

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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 Security:
Direct (D) or Indirect (I)

(Instr. 5)
6. Nature of
Indirect
Beneficial
Ownership

(Instr. 5)

      Date
Exer-
cisable
Expi-
ration
Date
 
Title
Amount
or
Number
of Shares
           

  Common Stock Option (Right to Buy)   3/11/04 3/11/13   Common Stock 66,666 $3.00   D  

  Common Stock Option (Right to Buy)   3/11/05 3/11/13   Common Stock 66,666 $3.00   D  

  Common Stock Option (Right to Buy)   3/11/06 3/11/13   Common Stock 66,668 $3.00   D  

         

         

         

         

         

         

         

Explanation of Responses:

/s/ Anthony J. Carbone   3/13/2003

**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 is insufficient, see Instruction 6 for procedure.

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