UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.G 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No.
Xerographic Laser Images Corporation
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(Name of Issuer)
Common Stock
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(Title of Class of Securities)
984118-10-9
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(CUSIP Number)
Check the following box if a fee is being paid with this statement. [ ]
A fee is not required only if the filing person: (1) has a previous statement on
file reporting beneficial ownership of more than five percent of the class of
securities described in Item i; and (2) has filed no amendment subsequent
thereto reporting beneficial ownership of five percent or less of such class.)
(See Rule 13d-7.)
*The remainder of this coverpage shall be filled out for a reporting
person's initial filing on this form with respect to the subject class of
securities, and for any subsequent amendment containing information which would
alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not
be deemed to be "filed" for the purpose of section 18 of the Securities Exchange
Act of 1934("Act") or otherwise subject to the liabilities of that section of
the Act but shall be subject to all other provisions of the Act (however, see
the Notes).
CUSIP NO. 984118-10-10 Page 2 of 5 Pages
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1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
Anthony D. D'Amelio
###-##-####
2 CHECK THE APPROPIATE BOX IF A MEMBER OF A GROUP*
N/A (a) [ ]
(b) [ ]
3 SEC USE ONLY
4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S.A.
5 SOLE VOTING POWER
Common Stock 381,554 Shares
NUMBER OF
SHARES 6 SHARED VOTING POWER
BENEFICIALLY
OWNED BY N/A
EACH
REPORTING 7 SOLE DISPOSITIVE POWER
PERSON
WITH 381,554 Shares
8 SHARED DISPOSITIVE POWER
N/A
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
Common Shares 381,554 Shares
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
Warrants 139,000
Preffered Stock 6,000
Options (which are exercisable) 26,667
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
12.5%
12 TYPE OF REPORTING
IN
*SEE INSTRUCTIONS BEFORE FILLING OUT!
INSTRUCTIONS FOR SCHEDULE 13G
INSTRUCTIONS FOR COVER PAGE
(1) Names and Social Security Numbers of Reporting Persons- Furnish the full
legal name of each person for whom the report is filed-i.e., each person
required to sign the schedule itself-including each member of a group. Do
not include the name of a person required to be identified in the report
but who is not a reporting person. Reporting persons are also requested to
furnish their Social Security or I.R.S. identification numbers, although
disclosure of such numbers is voluntary, not mandatory (see "SPECIAL
INSTRUCTIONS FOR COMPLYING WITH SCHEDULE 13G." Below).
(2) If any of the shares beneficially owned by a reporting person are held as a
member of a group and such membership is expressly affirmed, please check
row 2(a). If the membership is a group disclaimed or the reporting person
describes a relationship with other persons but does not affirm the
existence of a group, please check row 2(b) [unless a joint filing pursuant
to Rule 13d-1(e)(1) in which case it may not be necessary to check row
2(b)].
(3) The third row is for SEC internal use; please leave blank.
(4) Citizenship or Place of Organization-Furnish citizenship if the named
reporting person is a natural person. Otherwise, furnish place of
organization.
(5)-(9), (11) Aggregate amount Beneficially Owned By Each Reporting Person,
Etc.-Rows (5) through (9) inclusive, and (11) are to be completed in
accordance with the provisions of Item 4 of Schedule 13G. All percentages
are to be rounded off to the nearest tenth (one place after the decimal
point).
(10) Check if the aggregate amount reported as beneficially owned in row (9)
does not include shares to which beneficial ownership is disclaimed
pursuant to Rule 13d-4 (17 CFR 240. 13d-4) under the Securities Exchange
Act of 1934.
(12) Type of Reporting Person- Please classify each "reporting person" according
to the following breakdown (see Item 3 of Schedule 13G) and place the
appropriate symbol on the form:
Category Symbol
Broker Dealer BD
Bank BK
Insurance Company IC
Investment Company IV
Investment Advisor IA
Employee Benefit Plan, Pension Fund
or Endowment Fund EP
Parent Holding Company HC
Corporation CO
Partnership PN
Individual IN
Other OO
Notes:
Attach as many copies of the second part of the cover page as are
needed, one reporting person per page.
Filing persons may, in order to avoid unnecessary duplication, answer
item or items on the cover page(s). This approach may only be used where the
cover page item or items provide all the disclosure required by the schedule
item. Moreover, such a use of the cover page item will result in the item
becoming a part of the schedule and accordingly being considered a "filed" for
purpose of Section 18 of the Securities Exchange Act or otherwise subject to
liabilities of the section of the Act.
Reporting persons may comply with their cover page filing requirements
by filing either completed copies of the blank forms available from the
Commission, printed or typed facsimiles, or computer printed facsimiles,
provided the documents filed have identical formats to the forms prescribed in
the Commission's regulations and meet existing Securities Exchange Act rules as
to such matters as clarity and size (Securities Exchange Act Rule 12b-12).
SPECIAL INSTRUCTIONS FOR COMPLYING WITH SCHEDULE 13G
Under Sections 13(d), 13(g), and 23 of the Securities Exchange Act of
1934 and the rules and regulations thereunder, the Commission is authorized to
solicit the information required to be supplied by this schedule by certain
security holders of certain issuers.
Disclosures of the information specified in this schedule is mandatory,
except for Social Security or I.R.S. identification numbers, disclosure of which
is voluntary. The information will be used for the primary purpose of
determining and disclosing the holdings of certain beneficial owners of certain
equity securities. This statement will be made a matter of public record.
Therefore, any information will be available for inspection by any member of the
public.
Page 3 of 8 pages
Because of the nature of the information, the Commission can utilize it
for a variety of purposes, including referral to other governmental authorities
or securities self-regulatory organizations for investigatory purposes or in
connection with litigation involving the Federal securities law or other civil,
criminal or regulatory statues or provisions. Social Securities or I.R.S
identification numbers, if furnished, will assist the Commission in identifying
securities and, therefore, in promptly processing statements of beneficial
ownership of securities.
Failure to disclose the information requested by this schedule, except
for Social Security or I.R.S. identification numbers, may result in civil or
criminal action against the persons involved for violation of the Federal
securities laws and rules promulgated thereunder.
GENERAL INSTRUCTIONS
A. Statements containing the information required by this schedule shall be
filed not later than February 14 following the calendar year covered by the
statement or within the time specified in Rule 13d-1(b)(2), if applicable.
B. Information contained in a form which is required to be filed by rules
under section 13(f) (15 U.S.C. 78m(f)) for the same calendar year as that
covered by the statement in this schedule may be incorporated by reference
in response to any of the items of this schedule. If such information is
incorporated by reference in this schedule, copies of the relevant pages of
such a form shall be filed as an exhibit to this schedule.
C. The item numbers and captions of the items shall be included but the text
of the items is to be omitted. The answers to the items shall be so
prepared as to indicate clearly the coverage of the items without referring
to the text of the items. Answer every item. If an item is inapplicable or
the answer is in the negative, so state.
ITEM 1.
(A) Name of Issuer Xerographic Laser Images Corporation
(b) Address of Issuer's Principal Executive Offices
101 Billerica Avenue
North Billerica, MA 01864
ITEM 2.
(A) Name of Person Filing Anthony D. D'Amelio
(b) Address of Principal Business Office or, if none, Residence
25 Cleek Court
N. Reading, MA 01864
(c) Citizenship U.S.A.
(d) Title of Class of Securities Common Stock
(e) CUSIP Number 984118-10-9
ITEM 3. If this statement is filed pursuant to Rule 13d-1(b), or 13d-2(b), check
whether the person filing is a:
N/A
(a) Broker or Dealer registered under Section 15 of the Act
(b) Bank as defined in section 3(a)(19) of the Act
(c) Insurance Company as defined in section 3(a)(19) of the act
(d) Investment Company registered under section 8 of the Investment
Company Act
(e) Investment Advisor registered under section 203 of the
Investment Advisors Act of 1940
(f) Employee Benefit Plan. Pension Fund which is subject to the
provisions of the Employee Retirement Income Security Act of
1974 or Endowment Fund: see &240.13d-1(b)(ii)(0)(F)
(g) Parent Holding Company, in accordance with &240.13d-1(b)(ii)(0)
(Note: See Item 7)
(h) Group, in accordance with &240.13d-1(b)(ii)(H)
ITEM 4. OWNERSHIP
If the percent of the class owned as of December 31 of the year covered
by the statement, or as of the last day of any month described in Rule
13d-1(b)(2), if applicable, exceeds five percent, provided the following
information as of that date and identify those shares which there is a right to
acquire.
(A) Amount Beneficially Owned
N/A
(b) Percent of Class
N/A
Page 4 of 8 pages
(c) Number of shares as to which such person has:
(i) sole power to vote or to direct the vote
381,554 Shares of Common Stock
(ii) shared power to vote or to direct the vote N/A
(iii) sole power to dispose or to direct the disposition of
381,554 Shares of Common Stock
(iv) shared power to dispose to direct the disposition of
N/A
Instruction: For computations regarding securities which represent a right to
acquire an under lying security see Rule 13d-3(d)(1).
ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS
If this statement is being filed to report the fact that as of the date
hereof the reporting person has ceased to be the beneficial owner of more than
five percent of the class of securities, check the following .
Instruction: Dissolution of a group requires a response to this item.
ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON.
If any other person is known to have the right to receive or the power
to direct the receipt of dividends from, or the proceeds from the sale of, such
securities, a statement to that effect should be included in response to this
item and, if such interest relates to more than five percent of the class, such
person should be identified. A listing of the shareholders of an investment
company registered under the Investment Company Act of 1940 or the beneficiaries
of employee benefit plan, pension fund or endowment fund is not required.
ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE
SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY
If a parent holding company has filed this schedule, pursuant to Rule
13d-1(b)(ii)(G), so indicate under Item 3(g) and attach an exhibit stating the
identity and the Item 3 classification of the relevant subsidiary. If a parent
holding company has filed this schedule pursuant to Rule 13d-1(c), attach an
exhibit stating the identification of the relevant subsidiary.
ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP
If a group has filed this schedule pursuant to Rule 13d-1(b)(ii)(H), so
indicate under item 3(h) and attach an exhibit stating the identity and Item 3
classification of each member of the group. If a group had filed this schedule
pursuant to rule 13d-19c0, attach an exhibit stating the identity of each member
of the group.
ITEM 9. NOTICE OF DISSOLUTION OF GROUP
Notice of dissolution of a group may be furnished as an exhibit stating
the date of the dissolution and that all further filings with respect to
transactions in the security reported on will be filed, if required, by members
of the group, in their individual capacity. See Item 5.
ITEM 10. CERTIFICATION
The following certification shall be included if the statement is filed
pursuant to Rule 13d-1(b): By signing below I certify that, to the best of my
knowledge and belief, the securities referred to above were acquired in the
ordinary course of business and were not acquired for the purpose of and do not
have the effect of changing or influencing the control of the issuer of such
securities and were not acquired in connection with or as a participant in any
transaction having such purpose or effect.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
1/23/97
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Date
/s/ Anthony D. D'Amelio
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Signature
Anthony D. D'Amelio, President &CEO
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Name/Title
