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- ---------- U.S. SECURITIES AND EXCHANGE COMMISSION --------------------------
FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL
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/ / CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0287
LONGER SUBJECT TO EXPIRES: APRIL 30, 1997
SECTION 16. FORM 4 OR Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN
FORM 5 OBLIGATIONS MAY Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5
CONTINUE. SEE Section 30(f) of the Investment Company Act of 1940 -----------------------------
INSTRUCTION 1(b).
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1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Issuer (Check all applicable)
X Director 10% Owner
Snead, Charles D., Jr. Siskon Gold Corporation (SISK) ---- ----
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(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- title ---- (specify
Number of Reporting Month/Year below) below
PO Box 5528 Person (Voluntary) January, 1997
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(Street) 5. If Amendment,
Date of Original --------------------------
(Month/Year)
Carefree, AZ 85377
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(City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) action action or Disposed of (D) Securities ship of In-
Date Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Instr. 8) Owned at Direct Bene-
(Month/ End of (D) or ficial
Day/ ------------------------------------------- Month Indirect Owner-
Year) (A) or (I) ship
Code V Amount (D) Price (Instr. 3 (Instr. 4) (Instr. 4)
and 4)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses) SEC 1474 (8-92)
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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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1. Title of Derivative Security 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer-
(Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex-
Exercise Date (Instr. 8) quired (A) or Dis- piration Date
Price of (Month/ posed of (D) (Month/Day/
Deriv- Day/ (Instr. 3, 4, and 5) Year)
ative Year)
Security
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Date Expira-
-------------------------------------- Exer- tion
cisable Date
Code V (A) (D)
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Option to Purchase $0.781 1/1/97 A V 1,500 1/1/97 1/1/02
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7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Na-
lying Securities of of Deriv- ship ture
(Instr. 3 and 4) Deriv- ative Form of In-
ative Securi- of De- direct
Secur- ties rivative Bene-
ity Bene- Secu- ficial
(Instr. ficially rity: Own-
5) Owned Direct ership
at End (D) or (Instr. 4)
Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
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Class A Common Stock 1,500 grant 2,138 D
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Explanation of Responses:
CHARLES D. SNEAD, JR. 2/10/97
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**Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date
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.
Page 2
SEC 1474 (8-92)
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