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FORM 3 OMB NUMBER
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OMB Number: 3235-0104
U.S. SECURITIES AND EXCHANGE COMMISSION Expires: January 31, 2005
WASHINGTON, DC 20549 Extimated average burden
hours per response....0.5
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
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1. Name and Address of Reporting Person 2. Date of Event Requiring 4. Issuer Name and Ticker or Trading Symbol
Meyer, Anthony E. Statement
------------------------------------------ (Month/Day/Year) Park City Group, Inc. (PKCY)
(Last) (First) (Middle) October 28, 2002 -----------------------------------------------------------
551 5TH AVE #3100 ---------------------------- 5. Relationship of Reporting 6.If Amendment, Date
------------------------------------------ 3. IRS or Social Security Person to Issuer of Original
(Street) Number of Reporting (Check all applicable) (Month/Day/Year)
Person (Voluntary) [X] Director [ ] 10% Owner
NEW YORK, NY 10176 [ ] Officer [ ] Other(specify 7.Individual or Joint/Group
---------------------------------------- -------------------------- (give title below) Filing (Check Applicable
(City) (State) (Zip) below) Line)
[X] Form filed by One
Reporting Person
[ ] Form filed by More
than One Reporting
Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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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)
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NONE
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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 vaild OMB control number.
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Explanation of Responses:
/s/ Anthony E. Meyer 10/28/02
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**Signature of Reporting Person Date
Anthony E. Meyer
**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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays
a currently vaild OMB control number.
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