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FORM 5 OMB APPROVAL
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OMB Number: 3235-0362
Expires: September 30, 1998
[ ] Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION Estimated average burden
longer subject to WASHINGTON, DC 20549 hours per response......1.0
Section 16. Form -----------------------------
4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
obligations may
continue. See Filed pursuant to Section 16(a) of the Securities
Instruction 1(b) Exchange Act of 1934,
[ ] Form 3 Holdings Section 17(a) of the Public Utility
Reported Holding Company Act of 1935 or Section 30(f) of
[ ] Form 4 the Investment Company Act
Transactions of 1940
Reported
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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
Cogut, Craig M. Envirotest Systems Corp. (ENR) Issuer (Check all applicable)
- ------------------------------------------- ---------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
c/o Apollo Advisors, L.P. Number of Reporting Month/Year Officer (give Other (specify
2 Manhattanville Rd. Person (Voluntary) September 30, 1997 ---- title below) --- below)
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(Street) 5. If Amendment, Board Director
Purchase, NY 10577 Date of Original -------------------------------
- ------------------------------------------- (Month/Year)
(City) (State) (Zip) 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 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Issuer's Direct Benefi-
(Month/ Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
*If the form is filed by more than one Reporting Person, see Instruction 4(b)(v).
(Over)
Page 1 of 3 pages SEC 2270 (9-96)
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FORM 5 (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 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- (Month/ Disposed of (D) (Month/Day/ Secur-
ative Day/ (Instr. 3, 4, Year) ity
Security Year) and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Non-Qualified Stock Option
(right to buy) $3.3750 10/31/96 A 25,000 (1) 10/31/06 Common Stock 25,000
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1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative of Derivative Indirect
(Instr. 3) Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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Non-Qualified Stock Option
(right to buy) 25,000 D
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Explanation of Responses:
See continuation page(s) for footnotes
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ CRAIG COGUT 11-11-97
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- --------
**Signature of Reporting Person Date
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.
Page 2
Page 2 of 3 pages SEC 2270 (9-96)
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Cogut, Craig M. Envirotest Systems Corp. (ENR) Page 3 of 3 Pages
c/o Apollo Advisors, L.P. 9/30/97
2 Manhattanville Road
Purchase, NY 10577
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(1) Option exercisable in two equal annual installments beginning October 31, 1997.
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