-----------------------------
OMB APPROVAL
-----------------------------
OMB Number 3235-0362
Expires: September 30, 1998
Estimated average burden
hours per response ....... 1.0
------------------------------
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL 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
[ ] CHECK THIS BOX IF NO LONGER
SUBJECT OF SECTION 16. FORM 4
OR FORM 5 OBLIGATIONS MAY
CONTINUE. SEE INSTRUCTION 1(B).
[ ] FORM 3 HOLDINGS REPORTED.
[ ] FORM 4 TRANSACTIONS REPORTED.
======================================================================
1. Name and Address of Reporting Person
Burgess Debra L.
- ----------------------------------------------------------------------
(Last) (First) (Middle)
P.O. Box 2985
- ----------------------------------------------------------------------
(Street)
Coppell TX 75019
- ----------------------------------------------------------------------
(City) (State) (Zip)
======================================================================
2. Issuer Name and Ticker or Trading Symbol
ARDIS TELECOM & TECHNOLOGIES, INC. (RDST)
======================================================================
3. IRS or Social Security Number of Reporting Person (Voluntary)
======================================================================
4. Statement for Month/Year
October 1999
======================================================================
5. If Amendment, Date of Original (Month/Year)
======================================================================
6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ X ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
---------------------------
======================================================================
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>
<TABLE>
<CAPTION>
=================================================================================================================================
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
=================================================================================================================================
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7. Nature
Transaction (Instr. 3, 4 and 5) Beneficially Direct of Indirect
2. Code ------------------------------- Owned at End (D) or Beneficial
1. Transaction (Instr. 8) (A) of Issuer's Indirect Ownership
Title of Security Date ------------ or Fiscal Year (I) (Instr.
(Instr. 3) (mm/dd/yy) Code Amount (D) Price (Instr 3 & 4) (Instr.4) 4)
- ---------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
=================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
</TABLE>
<PAGE>
FORM 5 (continued)
<TABLE>
<CAPTION>
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
====================================================================================================================================
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
of Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code (A) (D) cisable Date Title Shares 5) 4) 4) 4)
- ---------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Employee Stock $.45 04/26/99 A 5,000 04/26/99 04/26/04 Common 5,000 5,000 D
Option (right Stock
to buy)
- ---------------------------------------------------------------------------------------------------------------------------------
Employee Stock $.40 04/26/99 A 5,000 04/26/99 04/26/01 Common 5,000 5,000 D
Option (right Stock
to buy)
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
=================================================================================================================================
</TABLE>
Explanation of Responses:
/s/ DEBBIE BURGESS 12/12/99
- -------------------------------------------- -------------
**Signature of Reporting Person Date
** 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 procedures.
