UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Approval
FORM 4 WASHINGTON, D.C. 20549 ------------------
|_| Check this box if no OMB Number 3235-0287
longer subject to Expires: December 31, 2001
Section 16. Form 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden
or Form 5 Hours per response....0.5
obligations may
continue Instruction
1(b).
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
(Print or Type Responses)
-------------------------------------------- ----------------------------------------------- ---------------------------------------
1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
Millard Marshall N. Billserv, Inc. BLLS Director 10% Owner
-------------------------------------------- ----------------------------------------------- --- ---
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for X Officer (give Other (specify
Number of Reporting Month/Year --- title below) --- below)
Person (Voluntary)
211 N. Loop 1604 East, Suite 100 December 2002 SVP, General Counsel
-------------------------------------------- ------------------- ---------------------------------------
(Street) 5. If Amendment, 7. Individual or Joint/Group Filing
Date of Original (Check Applicable Line)
(Month/Year) X Form filed by One Reporting Person
---
Form filed by More than One
San Antonio TX 78232 ---Reporting Person
-----------------------------------------------------------------------------------------------------------------------------------
(City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
----------------------------------------------------------------------------------------------------------------------------------
1.Title of Security 2.Trans- 3.Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7.Nature of
(Instr. 3) action action or Disposed of (D) Securities ship Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial
(Instr. 8) Owned at Direct Owner-
End of Month (D) or ship
(Month/ ------------------------------------- (Instr. 3 and Indirect (Instr. 4)
Day/ Code V Amount (A)or Price 4) (I)
Year) (D) (Instr.4)
------------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
* If the form is filed by more than one reporting person, see Instruction 4(b)(v). SEC 1474 (7-96)
FORM 4 (CONTINUED) TABLE II-- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
------------ ---------- -------- --------- ------------- ---------------- -------------- -------- --------- ---------- -------------
1.Title of 2.Conver- 3.Trans- 4.Trans- 5.Number of 6.Date Exer- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature
Derivative sion action action Derivative cisable and Amount of of of ship of
Security or Date Code Securities Expiration Underlying Deriv- Deriv- Form Indirect
Instr. 3) Exercise (Instr. Acquired Date Securities Ative ative of Beneficial
Price of (Month/ 8) (A)or (Month/Day/ (Instr. 3 Secur- Secur- Deriv- Ownership
Deri- Day/ Disposed of Year) and 4) ity ities ative (Instr.4)
vative Year) (D)(Instr. (Instr Bene- Security:
Security 3, 4 and 5) 5) ficially Direct
Owned (D) or
----- --- ------- ----- ------- -------- ------ ------- at End Indirect
Code V (A) (D) Date Expira- Title Amount of (I)
Exer- tion or Month (Instr.
cisable Date Number (Instr. 4)
of 4)
Shares
------------ ---------- -------- ----- --- ------- ----- ------- -------- ------ ------- -------- --------- ---------- -------------
Stock Option $0.18 12/31/02 A 100,000 (1) 12/31/12 Common 100,000 $0.18 D
------------ ---------- -------- ----- --- ------- ----- ------- -------- ------ ------- -------- --------- ---------- -------------
Stock Option $0.26 12/13/02 A 30,000 (2) 12/13/12 Common 30,000 $0.26 220,000 D
------------ ---------- -------- ----- --- ------- ----- ------- -------- ------ ------- -------- --------- ---------- -------------
Explanation of Responses:
(1) 1/3 on 12/31/03, 12/31/04 and 12/31/05
--------------------------------------------------------------------
(2) 1/3 on 6/13/03, 12/13/03 and 6/13/04 (cancellation and re-grant)
--------------------------------------------------------------------
/s/ 1/22/2003
**Intentional misstatements or omissions of facts constitute ----------------------------- ------------------
Federal Criminal Violations. **Signature of Reporting Person Date
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.
Page 2
SEC 1474 (7-96)