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, Section 17(a) of the Public Utility Holding Company Act of 1935 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*|
|ONE BLUE HILL PLAZA, 7TH FLOOR|
|2. Date of Event Requiring Statement (Month/Day/Year)|
|3. Issuer Name and Ticker or Trading Symbol |
PROVO INTERNATIONAL INC
|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 (Month/Day/Year)|
|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 Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
|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 Excercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)
||6. Nature of Indirect Beneficial Ownership (Instr. 5)
|Date Exercisable||Expiration Date||Title||Amount or Number of Shares|
|Explanation of Responses:|
|/s/ Miguel Madero||02/09/2004|
|** 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, 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. 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.|
|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.|