U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549 ----------------------------
INITIAL STATEMENT OF | OMB APPROVAL |
BENEFICIAL OWNERSHIP OF SECURITIES |--------------------------|
| |
| OMB NUMBER: 3235-0104 |
| EXPIRES: |
| February 1, 1994 |
Filed pursuant to Section 16(a) of the | ESTIMATED AVERAGE |
Securities Exchange Act of 1934, | BURDEN HOURS |
Section 17(a) of the Public Utility | PER RESPONSE 0.5 |
Holding Company Act of 1935 ----------------------------
or Section 30(f) of the Investment
Company Act of 1940
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1. Name and Address of Reporting Person
GOMBRICH PETER P.
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(Last) (First) (Middle)
c/o InPATH, LLC
900 N. FRANKLIN SUITE 210
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(Street)
CHICAGO ILLINOIS 60610
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
DECEMBER 4, 1998
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3. IRS OR SOCIAL SECURITY NUMBER OF REPORTING PERSON (VOLUNTARY)
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4. Issuer Name and Ticker or Trading Symbol
BELL NATIONAL CORPORATION - BLBN
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5. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER (CHECK ALL APPLICABLE)
(X) DIRECTOR
(X) 10% OWNER
(X) OFFICER -- CHAIRMAN OF THE BOARD, SECRETARY
(X) OTHER MEMBER OF 13(d) GROUP OWNING MORE THAN 10% (1)
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6. IF AMENDMENT, DATE OF ORIGINAL (MONTH/DAY/YEAR)
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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 BENEFICIALLY OWNED
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|1. TITLE OF SECURITY|2.AMOUNT OF |3. OWNERSHIP |4. NATURE OF INDIRECT
| (INSTR. 4) | SECURITIES | FORM DIRECT| BENEFICIAL OWNERSHIP
| | BENEFICIALLY| DIRECT (D) | (INSTR.5)
| | OWNED | OR INDIRECT|
| | (INSTR. 4) | (I) (INSTR.|
| | | 5) |
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(1) COMMON STOCK 2,256,590 D
(2) COMMON STOCK 275,683 I by THE EAG TRUST (2)
(3) COMMON STOCK 275,683 I by THE CMC TRUST (2)
(4) COMMON STOCK 275,683 I by THE MDG TRUST (2)
(5) COMMON STOCK 235,883 I by THE MSD TRUST (2)
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TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative Security (Instr. 4)
(1) WARRANTS
(2) WARRANTS
(3) WARRANTS
(4) WARRANTS
(5) WARRANTS
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2. Date Exercisable and Expiration Date (Month/Day/Year)
(1) 3/30/1999 12/31/2008
(2) 3/30/1999 12/31/2008
(3) 3/30/1999 12/31/2008
(4) 3/30/1999 12/31/2008
(5) 3/30/1999 12/31/2008
___________________________ _________________________
Date Exercisable Expiration Date
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3. Title and Amount of Securities Underlying Derivative Security (Instr.4)
(1) COMMON STOCK 1,671,005
(2) COMMON STOCK 204,144
(3) COMMON STOCK 204,144
(4) COMMON STOCK 204,144
(5) COMMON STOCK 174,672
___________________________ ___________________________
Title Amount of Number of Shares
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4. Conversion or Exercise Price of Derivative Security
(1) $.001
(2) $.001
(3) $.001
(4) $.001
(5) $.001
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5. Ownership Form of Derivative Security: Direct(D) or Indirect (I)
(Instr.5)
(1) D
(2) I
(3) I
(4) I
(5) I
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6. Nature of Indirect Beneficial Ownership (Instr. 5)
(1)
(2) by THE EAG TRUST
(3) by THE CMC TRUST
(4) by THE MDG TRUST
(5) by THE MSD TRUST
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EXPLANATION OF RESPONSES:
(1) MR. GOMBRICH ALSO SERVES AS THE TRUSTEE OF THE InPATH, LLC VOTING TRUST,
WHICH IS A MEMBER OF A 13(d) GROUP OWNING MORE THAN 10%.
(2) FOR THE BENEFIT OF FAMILY MEMBERS.
/s/ Jonathan A. Bohlen
His: Attorney-in-Fact DECEMBER 14, 1998
____________________________________________ ___________________
**SIGNATURE OF REPORTING PERSON Date
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** 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.
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.
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