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FORM 4 OMB APPROVAL
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[ ] Check this box if no longer OMB Number: 3235-0287
subject to Section 16. Form 4 Expires: January 31, 2005
or Form 5 obligations may Estimated average burden
continue. See Instruction 1(b). hours per response......05
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
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
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker Trading Symbol 6. Relationship of Reporting
Person(s) to Issuer
Park City Group, Inc. - PKCY (Check all applicable)
Wilson, Jr. Thomas W. [X] Director [ ] 10% Owner
----------------------------------------------------------------------------------------------- [ ] Officer(give [ ] Other (specify
(Last) (First) (Middle) 3. IRS Identification 4. Statement for Month/Year title below below)
Number of Reporting
14 Sea Spray Road Person, if an entity September 2002 ------------------------------
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(Street) 5. If Amendment, Date 7.Individual or Joint/Group
of Original Filing (Check Applicable Line)
(Month/Year) [X] Form filed by One Reporting
Person
[ ] Form filed by More than One
Reporting Person
Westport, CT 06880
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(City) (State) (Zip) TABLE 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired(A) 5. Amount of 6.Owner- 7. Nature of
(Instr. 3) action Code or Disposed of (D) Securities ship Indirect
Date (Instr.8) (Instr. 3,4 and 5) Beneficially Form: Beneficial
(Month/ -------------- ------------------------- Owned at End Direct (D) Ownership
Day/ Amount (A) or Price of Month or Indirect (Instr.4)
Year) Code V (D) (Instr. 3 and 4) (I) (Instr.4)
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2,875,000 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 on 4(b)(v).
Persons who respond to the collection of information contained in this form
are not required unless the form display a currently valid OMB control number.
FORM 4 (CONTINUED) Table II -- Derivative Securities Acquired, Disposed of, or Benficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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1.Title of 2.Conver- 3.Trans- 4.Tansac- 5.Number of 6.Date Exercis- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature
Derivative sion or action tion Derivative able and Amount of of of Deri- ship of In-
Security Exercise Date Code Securities Expiration Underlying Deri- vative Form of direct
(Instr.3) Price of (Month/ (Instr.8) Acquired Date Securities vative Secur- Deriva- Bene-
Deri- Day/ (A) or (Month/Day/ (Intr. 3 Secu- ities tive ficial
vative Year) Disposed Year) and 4) rity Benefi- Security: Owner-
Security of (D) ----------------- ------------- (Instr. cially Direct ship
(Instr.3, Amount 5) Owned (D) or (Instr.
4 and 5) or at End Indirect 4)
Date Expir- Title Number of (I)
Exer- ation of Month (Instr.4)
Code V (A) (D) cisable Date Shares (Instr.4)
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Option $0.25 9/30/02 I 666,667 9/30/02 Common 666,667 5,125,000 D
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Explanation of Responses:
EXPIRATION OF OPTION WITHOUT VALUE RECEIVED
** 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.
/s/ Thomas W. Wilson, Jr. 9/30/02
Potential persons who respond to the collection of information contained in -------------------------------- --------
this form are not required unless the form display a currently valid OMB control number. ** Signature of Reporting Person Date