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FORM 4
[ ]
Check this box if no longer |
UNITED STATES SECURITIES AND EXCHANGE
COMMISSION |
OMB APPROVAL OMB NUMBER: 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response...............0.5
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(Print or Type Responses) |
1. Name and
Address of Reporting Person* __________________________________ (Last) (First) (Middle) Grollman Michael A ________________________________ (Street) 4455 East Camelback Road Ste E-160 ________ _________ ____ (City) (State) (Zip) Phoenix AZ 85018 |
2. Issuer Name
and Ticker or Trading Symbol National Scientific Corporation NSCT |
6.
Relationship of Reporting Person(s) to Issuer (Check all applicable) [X ] Director [ ] 10% Owner [ X ] Officer (give title [ ] Other (specify below) below) Chief Operating Officer, Executive VP |
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3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) 86-0837077 |
4. Statement
for Month/Year 12/2000 |
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5. 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 I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||
1. Title of Security (Instr. 3) |
2. Transaction Date (Month/ Day/Year) |
3. Transaction Code (Instr. 8) |
4. Securities
Acquired (A) or Disposed of (D) (Instr. 3,4 and 5) |
5. Amount of Securities Beneficially Owned at End of Month (Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | Amount | (A) or (D) | Price | |||||
NSCT Common Stock | 12/04/2000 | P | V | 1000 | A | 1.88 | D | ||
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 4(b)(v).
Potential persons who are to respond to the collection of
information contained in this form are not required to
respond unless the form
displays a currently valid OMB control number.
(OVER)
FORM 4 (continued)
Table II - Derivative
Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
1. Title of
Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security |
3. Trans- action Date (Month/ Day/ Year) |
4. Trans- action Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/ Date/Year) |
7. Title and
Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr.5) |
9. Number of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
10. Ownership Form of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
11. Nature of Indirect Beneficial Owner- ship (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable |
Expiration Date |
Title | Amount or Number of Shares |
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/s/Michael A. Grollman | 12/8/00 | ||
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**Signature of Reporting Person | Date |
Explanation of Responses:
** Intentional misstatements or omissions of facts constitute
Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 7811(a).
Note: File three copies of this Form, one of which must be
manually signed. If space is insufficient, See
Instruction 6
for procedure.
Potential persons who are to respond to the collection of
information contained in this form are not required to
respond unless the form
displays a currently valid OMB control number.
PAGE 2
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