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
=====================================================================
1. Name and Address of Reporting Person
NBT Bancorp Inc.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
52 South Broad Street
- --------------------------------------------------------------------------------
(Street)
Norwich New York 13815
- --------------------------------------------------------------------------------
(City) (State) (Zip)
=====================================================================
2. Date of Event Requiring Statement (Month/Day/Year)
August 16, 1999
=====================================================================
3. IRS or Social Security Number of Reporting Person (Voluntary)
16-1268674
=====================================================================
4. Issuer Name and Ticker or Trading Symbol
Lake Ariel Bancorp, Inc. (NASDAQ NMS: LABN)
=====================================================================
5. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ X ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
<PAGE>
- ---------------------------------------------
================================================================================
6. If Amendment, Date of Original (Month/Year)
================================================================================
Table I -- Non-Derivative Securities Beneficially Owned
================================================================================
<TABLE>
<CAPTION>
<S> <C> <C> <C>
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)
- --------------------------------------------------------------------------------------------------------------------
N/A
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------
====================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
(Print or Type Responses)
</TABLE>
<PAGE>
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
<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)
- -----------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C>
Stock Option * * Common stock, 965,300 $11.375 D
- -----------------------------------------------------------------------------------------------------------------------------------
par value
- -----------------------------------------------------------------------------------------------------------------------------------
$.21 per share
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
- -
- -----------------------------------------------------------------------------------------------------------------------------------
===================================================================================================================================
</TABLE>
Explanation of Responses:
* In connection with the Agreement and Plan of Merger (the "Merger
Agreement"), dated August 16, 1999 whereby Lake Ariel Bancorp, Inc. ("Lake
Ariel") will merge with NBT Bancorp Inc. ("NBT"), Lake Ariel has granted
NBT an option to purchase up to 965,300 shares of Lake Ariel's common
stock. The option is exercisable only in the event of certain circumstances
involving transactions with third parties, acts of third parties, or
break-up of the Merger Agreement. If the option were exercised in full, NBT
would own 16.6% of Lake Ariel's then outstanding common stock. NBT
disclaims beneficial ownership of these securities, and this report shall
not be deemed an admission that NBT is the beneficial owner of such
securities for purposes of Section 16 or for any other purpose.
<PAGE>
/s/ Daryl R. Forsythe August 18, 1999
- ---------------------------------------------- -----------------------
President of NBT Bancorp Inc. Date
** Signature of Reporting Person
** 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.
