FORM 4 |
[ ] Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
1. Name and Address of Reporting Person
AXIA Group, Inc. |
2. Issuer Name and Ticker or Trading Symbol
Kelly's Coffee OTC-Bulletin Board Symbol = KLYS |
6. Relationship of Reporting Person to Issuer
___Director
| |
(Last) (First) (Middle) 268 West 400 South, Suite 300 |
3. IRS or Social Security Number of Reporting Person (Voluntary) |
4. Statement for Month/Year August, 2001 |
|
(Street) Salt Lake City, Utah 84101 |
5. If Amendment,
Date of Original (Month/Year) |
||
(City) (State) (Zip) |
1. Title of Security
(Instr. 3) |
2. Transaction
Date
(Month/Day/Year) |
3.
Transaction
Code (Instr. 8) |
4. Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of
Securities
Beneficially
Owned at End
of Month
(Instr. 3 & 4) |
6. Ownership
Form:
Direct (D) or Indirect (I) (Instr. 4) |
7. Nature
of
Indirect
Beneficial
Owner-ship
(Instr. 4) | |||
Code |
V |
Amount |
(A) or
(D) |
Price |
|||||
Common Stock | August 29, 2001 | S | 400,000 | D | $0.02 | 4,569,069 | D & I | Sub-sidiaries | |
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security |
3. Transaction Date (Month/ Day/Year) |
4. Trans-action Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4,& 5) |
6. Date Exercisable and Expiration Date (Month/ Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Deriv-ative Security (Instr.5) |
9. Number of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
10.Owner-ship Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature
of
Indirect
Beneficial Owner-ship (Instr. 4) | ||||
|
V |
|
|
Date Exer-cisable |
Expir-ation Date |
|
Amt.. or No. of Shares |
|||||||
Explanation of Responses:
** Intention misstatements or omission of facts constitute Federal Criminal Violations. December 3, 2001
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.
Date: December 3, 2001
/s/ Ed Haidenthaller
. **Signature of Ed Haidenthaller, Treasurer
Page 2
N:\Master\Clients\Kellys Coffee\SECDOCS\Forms 3 & 4\Form4-AXIA-08-29-01 Stock Sale.wpd SEC 1474 (8-92)