3 1 louisbenedictform3.txt INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES FOR DIRECTOR LOUIS P. BENEDICT OMB APPROVAL OMB Number: 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response .05 _________________________ 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1 (b). (Print or type responses) __________________________________________________ 1. Name and Address of Reporting Person* Benedict, Louis P. __________________________________________________ (Last) (First) (Middle) 20955 De Mina Street __________________________________________________ (Street) Woodland Hills CA 91364 __________________________________________________ (City) (State) (Zip) __________________________________________________ 2. Date of Event Requiring Statement (M/D/Y) 11/09/2002 __________________________________________________ 3. IRS Identification Number of Reporting Person, If an Entity (Voluntary) ###-##-#### __________________________________________________ 4. Issuer Name and Ticker or Trading Symbol Pismo Coast Village, Inc. __________________________________________________ 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) X Director ___ 10% Owner ___ Officer (give title) ______________________ ___ Other (specify) ___________________________ __________________________________________________ 6. If Amendment, Date of Original (M/D/Y) __________________________________________________ 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 I - Non-Derivative Securities Beneficially Owned ==============================================================================
1. Title of Security|2. Amount of Securities|3. Ownership Form:|4. Nature of Indirect | | Beneficially Owned | Direct (D) or | Beneficial Ownership | | | Indirect (I) | | ____________________|_______________________|___________________|_______________________| Common | One Share | D |N/A |
========================================================================================= Table II - Derivative Securities Beneficially Owned (e.g., Puts, calls, warrants, options, convertible securities) =========================================================================================
1. |2. |3. |4. |5. |6. | Title of |Date Exercisable|Title and Amount of|Conversion or |Ownership Form|Nature of | Derivative|and Expiration |Securities Under- |Exercise Price|of Derivative |Indirect | Security |Date (M/D/Y) |lying Derivative |of Derivative |Securities: |Beneficial| | |Security |Security |Direct (D) or |Ownership | | | | |Indirect (I) | | |________________|___________________| | | | |Date |Expi- |Title |Amount or| | | | |Exerci-|ration | |or Number| | | | |sable |Date | |of Shares| | | | __________|_______|________|_________|_________|______________|______________|__________| __________|_______|________|_________|_________|______________|______________|__________|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: /S/ LOUIS P. BENEDICT NOVEMBER 9, 2002 **Signature of Reporting Person Date * If the form is filed by more than one reporting person, see Instruction 5 (b)(v). ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U. S. C. 1001 and 15 U. S. C. 78 ff (a) Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.