U.S. SECURITIES AND EXCHANGE COMMISSION
FORM 3 Washington, D.C. 20549 OMB APPROVAL
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OMB Number: 3235-0104
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Expires: October 31, 2001
Estimated average burden
hours per response......0.5
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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 Re- 4. Issuer Name and Ticker
quiring Statement or Trading Symbol
Hovendick Mitchell D. (Month/Day/Year)
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(Last) (First) (Middle) 8/12/02 Billserv, Inc. BLLS
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3. IRS Identification 5. Relationship of Reporting 6. If Amendment, Date
Number of Reporting Person to Issuer of Original Filing
211 N. Loop 1604, Suite 200 Person, if an Entity (Check all applicable) (Month/Day/Year)
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(Street) X Director Owner 7. Individual or Joint/
--- --- Group
Officer Other (Check Applicable
--- (give --- (specify X Form filed by One
title below) below) --- Reporting
Person
-------------------------------- Form filed by
--- More than One
Reporting
San Antonio TX 78232 Person
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(City) (State) (Zip)
TABLE 1 - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3.Ownership 4. Nature of Indirect Beneficial Ownership
(Instr. 4) Beneficially Owned Form: Direct (Instr. 5)
Instr. 4) (D) or Indirect
(I) (Instr. 5)
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Common Stock 399,500 D
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Reminder : Report on a corporate line for each of securities beneficially owned
directly or indirectly. (Over) * If the form is filed by more them one reporting
person, SEE Instruction 5(b)(v).
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FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE
SECURITIES)
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1. Title of 2. Date Exercisable and 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of
Derivative Security Expiration Date Underlying Derivative Security sion or ship Indirect
(Instr. 4) (Month//Day/Year) (Instr. 4) Exercise Form of Beneficial
Price of Derivative Ownership
-------------------------------------------------------------- Derivative Security: (Instr. 5)
Date Expiration Title Amount or Security Direct (D)
Exercisable Date Number of shares or Indirect
(I)
(Instr. 5)
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Warrant 11/28/01 11/28/06 Common 169,900 $1.85 D
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Warrant (1) 08/12/12 Common 50,000 $0.81 D
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Explanantion of Responses:
(1) 1/3 vesting on 8/12/03, 8/12/04 and 8/12/05, respectively
/s/ Mitchell D. Hovendick 8/23/02
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** Signature of Reporting Person Date
** 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.
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 OMN Number.
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