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 |
|||||||||||||||||||||||||||||
OMB Number: 3235-0287 |
|||||||||||||||||||||||||||||||
Expires: December 31, 2001 |
|||||||||||||||||||||||||||||||
Estimated average burden hours per response...0.5 |
|||||||||||||||||||||||||||||||
1. Name and Address of Reporting Person* Danforth Jacqueline R.(Last) (First) (Middle) 335 - 25 Street S.E. Calgary Alberta T2A 7H8 |
2. Issuer Name and Ticker or Trading Symbol Synergy Technologies Corporation "OILS" |
6. Relationship of Reporting Person(s) to Issuer XX Director ___ 10% Owner XX Officer ___ Other (Give Title Below) (Specify Below) _____________________ _____________________ |
|||||||||||||||||||||||||||||
3. I.R.S. Identification Number of Reporting Person, If an entity (Voluntary)
|
4. Statement for Month/Year
|
7. Individual or Joint/Group Reporting XX Form Filed by One Reporting Person ___ Form Filed by More than One Reporting Person |
|||||||||||||||||||||||||||||
5. If Amendment, Date of Original (Month/Year) September 2000 |
|||||||||||||||||||||||||||||||
TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED |
|||||||||||||||||||||||||||||||
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) |
|||||||||||||||||||||||||
Code |
V |
Amount |
(A) or (D) |
Price |
|||||||||||||||||||||||||||
Common Stock |
09/28/00 |
P |
3,000 |
A |
2.03125 |
188,357(1) |
D |
||||||||||||||||||||||||
(1) Total number beneficially owned and shown on previously filed Form 4 contained a typographical error. |
|||||||||||||||||||||||||||||||
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., puts calls warrants options, convertible securities) |
|||||||||||||||||||||||||||||||
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) |
|||||||||||||||||||||
Code |
V |
(A) |
(D) |
Date Exer-cisable |
Expi-ration Date |
Title |
Amount or Number of Shares |
||||||||||||||||||||||||
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/ Jacqueline R. Danforth **Signature of Reporting Person |
March 5, 2001 |