U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
Mattingly, Reed
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(Last) (First) (Middle)
110 East Douglas Road
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(Street)
Oldsmar, FL 34677
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
EAUTOCLAIMS.COM, INC. (EACC)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Day/Year
November 26, 2002
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5. If Amendment, Date of Original (Month/Day/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Executive Vice President
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
2A. 3. Disposed of (D) Securities Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
Transaction Execution Code ------------------------------- Owned (D) or Indirect
1. Date Date, if any (Instr. 8) (A) Following Indirect Beneficial
Title of Security (Month/Day/ (Month/Day/ ------------ Amount or Price Reported (I) Ownership
(Instr. 3) Year) Year) Code V (D) Transaction(s) (Instr.4) (Instr. 4)
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Common Stock 11/26/02 M/X 25,463 A $0.01 171,130 D
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Common Stock (1) 11/26/02 J 84,034 A $0.119 255,164 D
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(1) - Represents conversion of note into commons shares.
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* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Response) (Over)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or 3A Derivative 6. of Underlying 8. ities Secur- of
Exer- Deemed 4. Securities Date Securities Price Bene- ity: In-
cise 3. Execu- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- tion action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Date, Code of(D) (Month/Day/Year) Amount ative following In- ficial
Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Reported direct Owner-
Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity Transac. (I) ship
Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. tion(s) (Instr. (Instr.
(Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4)
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Option to
aquire Common
common stock $0.01 11/26/02 M/X 25,463 7/29/02 7/29/12 stock 25,463 190,000 D
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Explanation of Responses:
/s/ Reed Mattingly 11/26/02
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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.
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