FORM 5
Check box if no longer Form 3 Holdings Reported X Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
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OMB APPROVAL |
OMB
Number: 3235-0362 |
1. Name and Address
of Reporting Person Payne, Melvin C. (Last) (First) (Middle)
(Street)
(City)
(State) (Zip) |
2. Issuer Name and
Ticker Carriage Services, Inc. CSV
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4. Statement for
Month/Year February 2003
5. If Amendment, Date
of / |
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X Director |
10% Owner |
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X Form Filed by One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of |
2. Transaction
Date |
2A. Deemed |
3. Transaction |
4. Securities Acquired (A) |
5. Amount of |
6. Owner- |
7. Nature of |
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Amount |
(A) or (D) |
Price |
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Common Stock |
12/16/2002 |
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G |
1,200 |
D |
$4.03 |
669,166 |
D |
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Common Stock |
12/23/2002 |
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G |
2,000 |
D |
$4.00 |
667,166 |
D |
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130,554 |
I |
Various |
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* If the form is filed by more than one reporting person, see instruction 4(b)(v).
Table II -
Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Derivative
Security |
2. Conver sion or Exercise Price of Derivative Security |
3. Transaction Date |
3A. Deemed Execution Date,
if any (Month/ |
4. Transaction Code |
5. Number of Derivative
Securities Acquired (A) or Disposed of (D) |
6. Date Exercisable and
Expiration Date |
7. Title and Amount of
Underlying Securities |
8. Price of Derivative
Security |
9. Number of Derivative
Securities Beneficially Owned at End of Year |
10.Ownership of Derivative
Security: |
11. Nature of Indirect Beneficial
Ownership |
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(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares |
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Explanation of Responses:
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/s/ Melvin C. Payne |
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2/10/2003 |
** Signature of Reporting Person |
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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.