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OMB APPROVAL
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OMB Number 3235-0287
Expires: April 30, 1997
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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
Woltjen Kevin S.
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(Last) (First) (Middle)
268 West 400 South, Suite 306
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(Street)
Salt Lake City, UT 84101
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
The Canton Industrial Corporation
CICP, CND
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
May 1996
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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)
[ ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
Vice President
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<PAGE>
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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>
Common Stock May 24, 1996 J(1) 75,950(2) A $1.875 75,950 D
Par Value $0.001
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(1) On May 24, 1966 The Canton Industrial Corporation granted Kevin S. Woltjen an option to purchase 75,950 shares of its common
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stock pursuant to its 1996 Stock Option Plan, which option was immediately exercised in full. The 1996 Stock Option Plan is not a
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Rule 16b-3 Plan.
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(2) Although Kevin S. Woltjen received 75,950 shares, all such shares bear an exercise price of 90% of the closing price of the
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common stock on the date of exercise, which exercise price for these shares is equal to $1.6875
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
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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>
Stock Option None May J(1) A 5/24/96 12/1/97 Commnon 19,263 Consid- one I (3)
24, 1996 Stock eration option
other
than cash
(2)
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</TABLE>
Explanation of Responses:
(1) On May 24, 1996 The Canton Industrial Corporation granted Kevin S. Woltjen
an option to purchase 19,263 shares of its common stock pursuant to its 1996
Stock Option Plan, none of which have been exercised. The 1996 Stock Option Plan
is not a Rule 16b-3 Plan.
(2) The consideration for the grant of the option was services previously
rendered to The Canton Industrial Corporation by Kevin S. Woltjen.
(3) Beneficial Ownership in the form of an unexercised option to purchase Common
Stock.
/s/ Kevin S. Woltjen June 14, 1996
**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.
