3 1 hav103.txt ----------- FORM 3 ---------- U.S. 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 ------------------------------------------- -------------------- ------------------------------------------------------ 1. Name and Address of Reporting person* 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol Requiring Statement Melius, Richard (Month/Day/Year) HAVEN HOLDING, INC. ----------------------------------------------------- (Last) (First) (Middle) 4/01/02 38 Hartman Hills Road ----------------------------------------------------- (Street) Huntington, NY 11743 ----------------------------------------------------- (City) (State) (Zip) ------------------------------------------- -------------------- ------------------------------------------------------ ------------------------------------------- -------------------- ------------------------------- ---------------------- 3. IRS 5. Relationship of Reporting 6. If Amendment Identification Person to Issuer (Check all Date of Original Number of applicable) (Month/Day/Year) Reporting Person, if an Entity [x] Director [x] 10% Owner N/A (Voluntary) [ ] Officer [ ] Other ###-##-#### (give title (specify below) below) ------------------------------------------- -------------------- ------------------------------- ---------------------- ------------------------------------------- -------------------- ------------------------------- ---------------------- 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 1 - NON DERIVATIVE SECURITIES BENEFICIALLY OWNED ----------------------------------------------------------------------------------------------------------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- 1.Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- Common stock 3,000,000 D -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ---------------------- -------------------------------------- ------------------------- ------------------------------- ----------------------

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). 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 control number.

FORM 3 (~~CONTINUED~~continued) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------ ------------------- ----------------------- ----------- ------------ --------------~~-----------------------~~ | 1. Title of Derivative ~~Security |~~2. Date |3. Title and Amount ~~of |~~4. ~~Conver- |~~ 5. ~~Owner- |~~6. Nature of ~~Indirect|~~Security |Exercisable of Securities Conver-sion Owner-ship Indirect (Instr. 4) ~~| Exercisable~~ and ~~| Securities~~ Underlying |Derivative ~~sion~~ or |Form ~~ship~~of | Beneficial ~~Owner- | | |~~ Expiration ~~Date~~Securities |exercise Derivative ~~Securities~~Ownership |Date ~~Exercise~~(Instr. |4) ~~Form~~price of |Security: ~~ship~~ (Instr. 5) ~~| | |~~ (Month/Day/Year) |Derivative ~~(Instr.~~Direct 4(D) |Security ~~Price~~or ofIndirect |(I) ~~Deriva-~~(Instr. |5) |------------------------------ |------------------- |----------------------- |----------- |------------ ~~Deriva~~-------------- ~~| tive | | | | | | tive | Security:| | | | | | Security | Direct | | | |~~--------------------|---------- --------- -------|-- |----------- ~~(D)~~----------- or----------- |------------ |-------------- ~~| |~~ Date | Expira-tion ~~| |~~ Amount/ ~~or | | Indirect | | | |~~ Exercis-| ~~tion~~Date | Title | Number of ~~| | (I) | | | |~~ able ~~| Date | |~~ Shares ~~| | (Instr. | | | | | | | | | 5) | | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------|-------------- |--------- |--------- |----------- |----------- |----------- |------------ |-------------- ~~| | |~~------------------------------ ---|------ ----|----- ----|------- -------|---- -------|---- --------|---- ---------|----- ----------------~~| | | | | | | | | | |~~-------------- --------- --------- -|----------| ---------|-- ----------- -|-----------| ------------|-- -----------|------------------- --|------- ~~| | | | | | | | | |~~--------- ----------- ----------- --|--------- -|---------|-- ------------|-- ---------|------------|--------- ----|----- --------- -------|---- ~~| | | | | | | | | |~~----------- ----------- -----------|- ---------|----- ----|--------------|-----------|- --------- --|------- ------|----- ----------- -----|------ ~~| | | | | | | | |~~ ------------ -------------- ------------------------------ --------- --------- ----------- ----------- ----------- ------------ -------------- ~~Explanation of Responses:~~ ------------------------------ ~~/s/~~--------- ~~Vicki~~--------- ~~J. Lavache 1/23/01 ** Intentional misstatements or omissions of facts constitute Federal Criminal~~ ----------- ----------- ----------- ------------ Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Vicki J. Lavache, President Note. File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. (Print or Type Responses) Page 2--------------

Explanation of Responses: -------------------------------- /s/ Richard Melius 4/9/02 ------------------------------- -------- **signature of reporting person Date Richard Melius **Intentional misstatement or omissions of facts constitute violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Potential persons who are to respond to the collection of information contained In this form are not required to respond unless the form displays a currently valid OMB Number. (Print or Type Responses) Page 2

Filing Compare · HAVEN HOLDING INC