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OMB APPROVAL
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OMB Number 3235-0104
Expires: April 30, 1997
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
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
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1. Name and Address of Reporting Person
CLARK, JAMES A.
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(Last) (First) (Middle)
150 Louisiana N.E.
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(Street)
Albuquerque, New Mexico 87108
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
(1)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
BOWLIN Outdoor Advertising & Travel Centers Incorporated; BWLN
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5 Relationship of Reporting Person to Issuer
(Check all applicable)
[X(1)] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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6. If Amendment, Date of Original (Month/Year)
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
None
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 7. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Security Exer- tion of Derivative (I) Ownership
(Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Options(2) (2) (3) Common Stock 6,000 (4) D
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</TABLE>
Explanation of Responses:
(1) Mr. Clark will become a director of the Company upon the Closing of the
Company's initial public offering.
(2) Options granted pursuant to the Company's 1996 Stock Option Plan. Options
are not exercisable until three (3) years from the date of grant.
(3) Options expire ten (10) years from the date of grant, which is the effective
date of Form SB-2 Registration Statement No. 333-12957 for the Company's
initial public offering (the "Public Offering").
(4) The exercise price per share is equal to the price per share at which the
Common Stock is initially offered to the public in the Public Offering.
/s/ James A. Clark 11-25-96
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**Signature of Reporting Person Date
James A. Clark
** 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.
