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OMB APPROVAL
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- ------ OMB Number: 3235-0362
FORM 5 Expires: December 31, 2001
- ------ Estimated average burden
hours per response.... 1.0
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
[X] CHECK BOX IF NO
LONGER SUBJECT TO
SECTION 16. FORM
4 OR FORM 5
OBLIGATIONS MAY
CONTINUE. SEE Filed pursuant to Section 16(a) of the Securities
INSTRUCTION 1(b). Exchange Act of 1934,
[ ] FORM 3 HOLDINGS Section 17(a) of the Public Utility
REPORTED Holding Company Act of 1935 or Section 30(f) of
[ ] FORM 4 the Investment Company Act
TRANSACTIONS of 1940
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(s) to
Munoz Jaime MSI Holdings, Inc. (MSIA) Issuer (Check all applicable)
- ------------------------------------------- --------------------------------------------- Director 10% Owner
(Last) (First) (Middle) 3. I.R.S. Identification 4. Statement for ---- ---
501 Waller Number of Reporting Month/Year X Officer (give Other (specify
- ------------------------------------------- Person, if an entity Fiscal Year 1999 ---- title --- below)
(Street) (Voluntary) ------------------- below)
Austin, TX 78702 5. If Amendment,
- ------------------------------------------- Date of Original -------------------------------
(City) (State) (Zip) (Month/Year)
7. Individual or Joint/Group Reporting
------------------ (Check applicable line)
X Form Filed by one
---- Reporting Person
Form Filed by More than
---- One Reporting Person
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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
(Month/ (Instr. end of Issuer's Direct Benefi-
Day/ 8) Fiscal Year (D) or cial
Year) ---------------------------- (Instr. 3 and 4) Indirect Owner-
Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr. 4)
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*If the form is filed by more than one reporting person, see Instruction 4(b)(v).
(Over)
SEC 2270 (3-99)
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.
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<TABLE>
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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)
<S> <C> <C> <C> <C> <C> <C> <C>
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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 Number of
(A) (D) cisable Date Title Shares
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<S> <C> <C>
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)
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Explanation of Responses:
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Jaime Munoz 5/17/99
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 is insufficient, see Instruction 6 for procedure. SEC 2270 (3-99)
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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 number.
