On: Friday, 1/30/04, at 1:52pm ET · For: 1/20/04 · As: 10% Owner · Accession #: 1277505-4-1 · File #: 0-31042
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Initial Statement of Beneficial Ownership of Securities — Form 3
Filing Table of Contents
Document/Exhibit Description Pages Size
1: 3 Initial Statement of Beneficial Ownership of HTML 5K
Securities -- primary_doc.xml/2.1
This ‘3’ Document is an XML Data File that may be rendered in various formats: Form 3 – Plain Text – SEC Website – EDGAR System – XML Data – <?xml?> File
SEC Info rendering: Initial Statement of Beneficial Ownership of Securities
|FORM 3||UNITED STATES SECURITIES AND EXCHANGE COMMISSION|
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|Estimated average burden|
|hours per response:||0.5|
|1. Name and Address of Reporting Person*
|2. Date of Event Requiring Statement
|3. Issuer Name and Ticker or Trading Symbol
U S CANADIAN MINERALS INC
[ UCAD ]
|4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)||
||Other (specify below)|
||5. If Amendment, Date of Original Filed
|6. 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.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
|Preferred Series A||10,000||D||
|Preferred Series A||4,850||I||Affiliated ownership with another corporate shareholder|
|Common Shares||5,000,000||I||Affiliated ownership with another corporate shareholder|
|Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
(Month/Day/Year)||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
|Date Exercisable||Expiration Date||Title||Amount or Number of Shares|
|Explanation of Responses:|
|John E. Dhonau, President IB 2000, Inc.|| 1/30/04|
||** Signature of Reporting Person||Date|
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
Instruction 6 for procedure.|
|Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.|
Filing Submission 0001277505-04-000001 – Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)
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