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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
1. Name and Address of Reporting Person:
Kirk Blosch, 2081 South Lakeline Drive, Salt Lake City, UT 84109
2. Date of Event Requiring Statement (Month/Date/Year): 05/16/96
3. IRS or Social Security Number of Reporting Person (Voluntary):
4. Issuer Name and Ticker or Trading Symbol:
Zevex International, Inc. (ZVX)
5. Relationship of Reporting Person(s) to Issuer (Check all Applicable)
( ) Director ( ) Officer, give title below (X) 10% Owner ( ) Other
Title:
6. If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Filing (Check Applicable Line)
(X) Form filed by One Reporting Person
( ) Form filed by More than One Reporting Person
<TABLE>
<CAPTION> TABLE I - Non-Derivative Securities Beneficially Owned
1. Title of Security 2. Amount of 3. Ownership 4. Nature of
Securities Form: Direct Indirect
Beneficially (D) or Beneficial
Owned Indirect (I) Ownership
- -------------------- --------------- --------------- ---------------
<S> <C> <C> <C>
Common Stock 250,000 I Owned by Blosch
& Holmes, LLC, of
which Reporting
Person owns 50%
Common Stock 125,000 D
</TABLE>
<TABLE>
<CAPTION> TABLE II - Derivative Securities Beneficially Owned
1. Title of 2. Date Exercisable 3. Title and Amount of 4. Conver- 5.
Ownership 6. Nature
Derivative and Expiration Securities Underlying sion or Form
of Of
Security Date (Month Day Derivative Security Exercise
Derivative Indirect
Year) Price of
Security: Ownership
------------------- ---------------------- Derivative Direct (D)
Date Exer- Expira- Title Amount or Security Or
Indirect
cisable tion Number of (I)
Date Shares
- ----------- ---------- -------- ----------- ---------- ----------
- ----------- ----------
<S> <C> <C> <C> <C> <C> <C>
<C>
Warrants to
Purchase
Common
Stock 2/18/97 2/18/02 Common 175,000 $3.50
D N/A
Stock
</TABLE>
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Explanation of Responses:
Signature of Reporting Person:
- ------------------------------------
Kirk Blosch
Date: 5/29/97
