<PAGE>
FORM 4
[ ] Check this box if no longer subject
to Section 16. Form 4 or Form 5
obligations may continue. See
Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
(Print or type responses)
_______________________________________________________________________________
1. Name and Address of Reporting Person
Schmid, Peter
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(Last) (First) (Middle)
Schlickgasse 1
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(Street)
A-1090 Vienna, Austria
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(City) (State) (Zip)
_______________________________________________________________________________
2. Issuer Name and Ticker or Trading Symbol
Czech Industries, Inc. (CZCH)
_______________________________________________________________________________
3. IRS or Social Security Number of Reporting Person (Voluntary)
XXX-XX-XXXX
_______________________________________________________________________________
4. Statement for Month/Year
XXXXXXXXXXXXXXXXXXX
_______________________________________________________________________________
5. If Amendment, Date of Original (Month/Year)
September 1996
_______________________________________________________________________________
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[X] 10% Owner
[X] Director
[X] Officer (give title below)
[ ] Other (specify below)
President and Chief Operating Officer
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--------------------------------------------------
_______________________________________________________________________________
7. Individual or Joint/Group Filing (Check Applicable Line)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
_______________________________________________________________________________
Page 1
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FORM 4 (continued)
<TABLE>
<CAPTION>
TABLE I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned*
- ------------------------------------------------------------------------------------------------------------------------
1. 2. 3. 4. 5. 6. 7.
- --------------------- -------- ---------- ------------------------------ ----------- ---------- ----------
Amount of Owner-
Securities ship
Trans- Trans- Securities Acquired (A) Beneficially Form:
action action or Disposed of (D) Owned at Direct Nature of
Date Code (Instr. 3, 4 and 5) End of (D) or Indirect
Title of (Month/ (Instr. 8) ---------------------------- Month Indirect Beneficial
Security Day/ ---------- Amount (A) or Price (Instr. (I) Ownership
(Instr. 3) Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4)
- --------------------- -------- ---- ---- ----------- ------ --------- ----------- ---------- ----------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock, Par value
$.05 per share 9/11/96 P 5,000 A $6.00 I (1)
Common Stock, Par value
$.05 per share 9/11/96 P 5,000 A $6.125 I (1)
Common Stock, Par value
$.05 per share 9/20/96 P 10,000 A $5.375 798,750 I (1)
Common Stock, Par value
$.05 per share 194,734 D (1)
</TABLE>
EXPLANATION OF RESPONSES:
1) 238,825 shares are owned indirectly through KHS Beteiligungs AG ("KHS")
over which Mr. Schmid shares control. 200,000 shares are owned by
Karntner Landes und Hypothekenbank AG ("Bank") as nominee for KHS.
359,925 shares are held by the Bank as nominee for the Tsuyoshi Trust
Vaduz and 194,734 are held by the bank as nominee for Mr. Schmid.
Mr. Schmid has sole voting and investment power with respect
to the trust shares and is a beneficiary of this trust.
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).
Page 2
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FORM 4 (continued)
<TABLE>
<CAPTION>
TABLE II--Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g. puts, calls, warrants, options, convertible securities)
- ------------------------------------------------------------------------------------------------------------------------------
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
- ---------- -------- -------- -------- ---------- ------------ -------------- ------ ---------- --------- ----------
Title and Ownership
Number of Date Exer- Amount of Form of
Derivative cisable and Underlying Number of Deriv-
Securities Expiration Securities Price Derivative ative
Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security:
sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct
Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of
Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect
Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial
Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership
(Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4)
- ---------- -------- -------- ---- --- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ----------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
</TABLE>
Explanation of Responses:
(1) 238,825 shares are owned indirectly through KHS Beteligungs AG ("KHS") over
which Mr. Schmid shares control. 200,000 shares are owned by Karntner
Landes und Hypothekenbank AG ("Bank") as nominee for KHS. 359,925 shares
are held by the Bank as nominee for the Tsuyoshi Trust Vaduz and 194,734
shares are held by the Bank as nominee for Mr. Schmid. Mr. Schmid has sole
voting and investment power with respect to the trust shares and is a
beneficiary of the trust.
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/s/ PETER SCHMID 4/4/97
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** Signature of Reporting Person Date
PETER SCHMID
** 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 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.
* Adjusted to reflect one-for-five reverse split of the Company's common stock
effective September 10, 1996.
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