SEC FORM 3 SEC Form 3
FORM 3 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
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
SELATI ROBIN P

(Last) (First) (Middle)
THREE FIRST NATIONAL PLAZA
SUITE 3800

(Street)
CHICAGO IL 60602

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/14/2006
3. Issuer Name and Ticker or Trading Symbol
CARROLS RESTAURANT GROUP, INC. [ TAST ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 6,396,536 I See Footnote(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Madison Dearborn Capital Partners, L.P. ("MDCP") is the record owner of 3,198,262 of the shares set forth herein and Madison Dearborn Capital Partners II, L.P. ("MDCPII") is the record owner of 3,198,274 of the shares set forth herein. The shares held by MDCP may be deemed to be beneficially owned by Madison Dearborn Partners, L.P. ("MDP"), the sole general partner of MDCP. The shares held by MDCPII may be deemed to be beneficially owned by Madision Dearborn Partners II, L.P. ("MDPII"), the sole general partner of MDCPII. Mr. Selati is a managing director of the general partner of MDP and MDPII (and a limited partner of MDPII), and therefore may be deemed to share beneficial ownership of the shares owned directly by MDCP and MDCPII. Mr. Selati expressly disclaims beneficial ownership of the shares owned by MDCP and MDCPII, except to the extent of his pecuniary interest therein.
/s/ Mark B. Tresnowski, as Attorney-in-Fact 12/14/2006
** Signature of Reporting Person Date
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).
** 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.
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