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OMB APPROVAL
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OMB Number 3235-0287
Expires: September 30, 1998
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[ ] Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person
FONG HENRY
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(Last) (First) (Middle)
7315 EAST PEAKVIEW AVENUE
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(Street)
ENGLEWOOD COLORADO 80111
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
EQUITEX, INC. (EQTX)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
###-##-####
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4. Statement for Month/Year
NOVEMBER 1997
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ X ] Director [ X ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
PRESIDENT AND TREASURER
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7. Individual or Joint/Group Filing (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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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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COMMON STOCK, $.02 PAR VALUE 11/04/97 P 15,000 A $1.94 15,000 I SEE (1)
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COMMON STOCK, $.02 PAR VALUE 389,784 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
<PAGE>
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
OPTION TO PURCHASE $3.00 12/28/ 12/28/ COMMON 30,500
COMMON STOCK 1993 1998 STOCK
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OPTION TO PURCHASE $3.00 12/28/ 12/28/ COMMON 176, 206,545 D
COMMON STOCK 1993 1998 STOCK 045
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</TABLE>
Explanation of Responses:
(1) Shares purchased and owned by wife of reporting person. Reporting person
has no pecuniary interest, investment or voting power with respect to the
shares and disclaims beneficial ownership.
/S/ HENRY FONG DECEMBER 10, 1997
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**Signature of Reporting Person Date
** 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 procedures.
