FORM 4
[ ] Check this box if no longer subject
to Section 16. Form 4 or Form 5
obligations may continue. See
Instructions 1(b).
U.S. 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
_______________________________________________________________________________
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 Vienia, Austria
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(City) (State) (Zip)
_______________________________________________________________________________
2. Issuer Name and Ticker or Trading Symbol
Czech Industries, Inc. (CZCH)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
XXX-XX-XXXX
_______________________________________________________________________________
4. Statement for Month/Year
XXXXXXXXXXXXXXXXXXX
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5. If Amendment, Date of Original (Month/Year)
October 1996
_______________________________________________________________________________
6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] 10% Owner
[X] Director
[X] Officer (give title below)
[ ] Other (specify below)
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President and Chief Operating Officer
_______________________________________________________________________________
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
<PAGE>
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 10/7/96 P 11,150 A $4.50 I (1)
Common Stock, par
value $.05 per share 10/10/96 P 20,000 A $4.25 I (1)
Common Stock, par
value $.05 per share 10/10/96 P 93,300 A $4.125 I (1)
Common Stock, par
value $.05 per share 10/16/96 P 5,000 A $6.00 I (1)
Common Stock, par
value $.05 per share 10/17/96 P 5,000 A $6.00 933,200 I (1)
Common Stock, par
value $.05 per share 194,734 D
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Print or Type Responses)
* If the form is filed by more than one reporting person
see Instruction 4(b)(v).
Page 2
<PAGE>
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) 373,275 shares are owned indirectly through KHS Beteilgungs AG ("KHS") over
which Mr. Schmid shares control, 200,000 shares are owned by Karntner Landes
und Hypothekenbank AG (the "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.
* Adjusted to reflect one-for-five reverse, split of the Company's common stock
effective September 10, 1996.
/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 provided is insufficient, see Instruction 6 for procedure.
Potential people 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.
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