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(f) of the Investment Company Act of 1940
1. Name and Address of Reporting Person
Garrison, Thomas A.
1120 Silver Sands Avenue
Naples, Florida 34109
2. Date of Event Requiring Statement (Month/Day/Year)
05/10/97
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Issuer Name and Ticker or Trading Symbol
Citizens Community Bancorp. Inc.
5. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
6 If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Filing (Check Applicable Line)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
<TABLE>
<CAPTION>
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Table I -- Non-Derivatie Securities Beneficially Owned
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership
Beneficially Owned Form: Direct (D)
or Indirect (I)
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<S> <C> <C> <C>
Common Stock - 5,800 D
Par Value - $0.01
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Common Stock - 3,200 I U.S. Clearing C/F TBG IRA
Par Value - $0.01
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Common Stock - 500 I U.S. Clearing C/F Gretchen Garrison IRA
Par Value - $0.01
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Table II --Derivative Securities Beneficially Owned (e.g., puts, calls,
warrants, options, convertibel securities)
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1. Title of 2. Date Exercisable 3. Title and Amount 4. Conversion or 5. Ownership 6. Nature of
Derivative and Expiration Date of Securities Exercise Price Form of Indirect
Security Date Expiration Underlying of Derivative Derivative Beneficial
Exercisable Date Derivative Security Security Security: Ownership
Title Amount or Direct (D)
Number of or Indirect (I)
Shares
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<S> <C> <C> <C> <C> <C> <C> <C>
Warrants 3/14/96 6/18/98 Common Stock - 400 $9.00 D
Par Value - $0.01
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Warrants 2/7/96 6/18/98 Common Stock - 1,100 $9.00 I U.S. Clearing C/F
Par Value - $0.01 TBG IRA
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Warrants 2/14/96 6/18/98 Common Stock - 500 $9.00 I U.S. Clearing C/F
Par Value - $0.01 TBG IRA
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Warrants 2/7/96 6/18/98 Common Stock - 250 $9.00 I U.S. Clearing C/F
Par Value - $0.01 Gretchen Garrison
</TABLE>
/s/Thomas B. Garrison 4/21/97
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Signature of Reporting Person Date
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