FORM 3 OMB APPROVAL
OMB Number: 3235-0104
Expires: January 31, 2005
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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
(Print or Type Responses)
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1. Name and Address of Reporting Person* 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol
Requiring Bravo! Foods International Corp. (BRVO)
Statement ---------------------------------------------------------------
(Month/Day/Year) 5. Relationship of Reporting 6. If Amendment, Date of
Toulan Roy D. Jr. January 1, 2003 Person(s) to Issuer Original (Month/Day/Year)
----------------------------------------- ------------------- (Check all applicable)
(Last) (First) (Middle) 3. I.R.S. Identi- [ ] Director -------------------------------
fication Number [ ] 10% Owner 7. Individual or Joint/Group
c/o Bravo! Foods International Corp. of Reporting [X] Officer (give title Filing (Check Applicable
11300 U.S. Highway 1, Suite 202 Person, if an below) Line)
----------------------------------------- entity [ ] Other (specify below) [X] Form filed by One
(Street) (voluntary) Reporting Person
Vice President [ ] Form filed by More than
North Palm Beach, FL 33404 _____________________ One Reporting Person
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(City) (State) (Zip)
Table I -- Non-Derivative Securities Beneficially Owned
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1. Title of Security |2. Amount of |3. Ownership |4. Nature of Indirect Beneficial Ownership
(Instr. 4) | Securities | Form: | (Instr. 5)
| Beneficially | Direct (D) |
| Owned | or |
| (Instr. 4) | Indirect (I) |
| | (Instr. 5) |
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Common Stock | 115,000 | D |
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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).
SEC 1473 (7/02)
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
control nummber.
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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 Derivative |2. Date Exercisable |3. Title and Amount of Securities |4. Conver- |5. Ownership |6. Nature of
Security | and Expiration | Underlying Derivative Security | sion or |Form of | Indirect
(Instr. 4) | Date(Month/Day/Year) | (Instr. 4) | Exercise |Derivative | Beneficial
| | | Price of |Security: | Ownership
| | |Amount or | Derivative |Direct (D) or | (Instr. 5)
|Date |Expiration | |Number of | Security |Indirect (I) |
|Exercisable |Date |Title |Shares | |(Instr. 5) |
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Options | 1/1/03 | 12/31/07 | Common Stock | 100,000 | $0.40/share | D |
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Explanation of Responses:
/s/ Roy D. Toulan, Jr. January 2, 2003
_________________________________ _______________
** 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 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 OMB Number.
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