FORM 4
[ ] Check this box if no longer OMB APPROVAL
subject to Section 16. Form 4 OMB Number: 3235-0287
or Form 5 obligations may Expires: September 30, 1998
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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
1. Name and Address of Reporting Person
Roberts, Merle W.
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(Last) (First) (Middle)
2609 S. Everglade St.
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(Street)
Santa Ana, CA 92704
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(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Dental/Medical Diagnostic Systems, Inc.
Stock: DMDS Warrants: DMDSW
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement for Month/Year:
February 1999
5. If Amendment, Date of Original(Month/Year)
6. Relationship of Reporting Person to Issuer
(Check all applicable)
Director 10% Owner
--- ---
X Officer (give Other (specify
--- title below) --- below)
Vice President of Manufacturing
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TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED,
DISPOSED OF, OR BENEFICIALLY OWNED
<TABLE>
<CAPTION>
1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
(Instr. 3) action Code or Disposed of (D) Securities Form; Indirect
Date (Instr. 8) Beneficially Direct (D) Beneficial
(Instr. 3, 4 and 5) Owned at End or Indirect Ownership
(Month/ ----------------------------------------- of Month (I)
Day/ Code V Amount (A) or Price (Instr. 4)
Year) (D) (Instr. 3 and 4) (Instr. 4)
- ------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock (DMDS) 2-10-99 S 1,300 D $8.00 5,000 D
Common Stock (DMDS) 2-26-99 S 5,000 D 7.375 5,000 D
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Over)
* If the form is filed by more than one reporting person,
SEE Instruction 4(b)(v).
(Print or Type Responses) SEC 1474(7-96)
<PAGE>
FORM 4 (CONTINUED)
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<TABLE>
<CAPTION>
1.Title 2.Conver- 3.Trans- 4.Trans- 5.No. of 6.Date Exer- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature
of Deri- sion or action action Deri- cisable Amount of of of Deriv- ship of In-
vative Exercise Date Code vative and Expi- Underlying Deri- ative Form of direct
Security Price of (Month/ (Instr. Securi- ration Securities vative Securities Deriva- Bene-
(Instr. 3) Deri- Day/ 8) ties Ac- Date (Month/ (Instr. 3 Security Bene- tive ficial
vative Year) quired Day/Year) and 4) (Instr. 5) ficially Security; Owner-
Security (A) or Owned at Direct ship
Disposed End of (D) or (Instr.
of (D) Month Indirect 4)
(Instr. 3, (Instr. 4) (I)
4, and 5) (Instr. 4)
--------- ---------- -----------------------------
Code V (A) (D) Date Expira- Amt. or
Exer- tion Title No. of
cis- Date Shares
able
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Warrants 5.00 2-22-99 S 10,000 * * Common 10,000 3.25 20,000 D
(DMDSW) Stock
</TABLE>
Explanation of Responses:
* Warrants may be exercised only during the period commencing on 5-9-98 and
terminating on the earlier of 5-8-2002 or the date fixed for redemption by the
Company as provided for in the Warrant Agreement.
**Intentional misstatements or omissions of facts constitute Federal
Criminal Violations.
SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/S/ MERLE W. ROBERTS 3-24-99
------------------------------- ----------
**Signature of Reporting Person Date
Note: File three copies of this Form, one of which must be manually
signed. If space provided 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 Number. SEC 1474 (8-92)
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