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FORM 5 OMB APPROVAL
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OMB Number: 3235-0362
Expires: April 30, 1997
Estimated average burden
hours per response......1.0
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
/ / Check box if no ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
longer subject to
Section 16. Form Filed pursuant to Section 16(a) of the Securities
4 or Form 5 Exchange Act of 1934,
obligations may Section 17(a) of the Public Utility
continue. See Holding Company Act of 1935 or Section 30(f) of
Instruction 1(b) the Investment Company Act
/ / Form 3 Holdings of 1940
Reported
/ / Form 4
Transactions
Reported
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<S> <C> <C> <C> <C> <C> <C>
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1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Fernandez Claude Carey Diversified LLC "CDC" Issuer (Check all applicable)
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(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year X Officer (give Other (Specify
1615 72nd Street Person (Voluntary) 12/31/98 ---- title --- below)
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(Street) 5. If Amendment, Executive Vice President,
Date of Original Financial Operations
North Bergen, NJ 07047 (Month/Year) ------------------------
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(City) (State) (Zip)
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Issuer's Direct Benefi-
(Month/ Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Listed Shares 8018(2) D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
SEC 2270(3/91)
(Print or Type Responses)
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FORM 5 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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Options
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9. Number of 10. Ownership 11. Nature of
Derivative of Derivative Indirect
Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
<S> <C> <C> <C>
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Explanation of Responses:
(1) On May 7, 1998, the reporting person filed a Form 4 reporting the acquisition of 6,500 shares that were to have been paid as
a bonus. This bonus was never paid.
(2) This number also includes 61 shares acquired in July and October, 1998 through Carey Diversified LLC's dividend
reinvestment plan.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Claude Fernandez 2/1/99
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------
**Signature of Reporting Person Date
Note: File three copies of this Form, one of which must be manually signed. Page 2
If space provided is insufficient, see Instruction 6 for procedure. Sec 2270 (3/91)
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