UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
( ) Check this box if no longer subject to Section 16.
Form 4 or Form 5 obligations may continue. See Instructions 1(b).
1. Name and Address of Reporting Person
JONAS AF JOCHNICK
WATERLOO OFFICE PARK
BUILDING O
DREVE RICHELLE, 161
B-1410 WATERLOO, BELGIUM
2. Issuer Name and Ticker or Trading Symbol
BALTIC INTERNATIONAL USA, INC.
BISA
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement for Month/Year
September 1997
5. If Amendment, Date of Original (Month/Year)
6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
(X) Director (X) 10% Owner ( ) Officer (give title below) ( ) Other
(specify below)
7. Individual or Joint/Group Filing (Check Applicable Line)
( ) Form filed by One Reporting Person
(X) Form filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect |
| Transaction | or Disposed of (D) | Securities |ect | Beneficial Ownership |
| | | | Beneficially |(D)or | |
| | | | | A/| | Owned at |Indir | |
| Date |Code|V| Amount | D | Price | End of Month |ect(I)| |
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<S> <C> <C> <C><C> <C> <C> <C> <C> <C>
Common Stock |8/19/97 |P | | 1250000 |A |$0.40 |2500000 |I |Owned by Celox S.A. |
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Common Stock |8/19/97 |P | | 2500000 |A |$0.40 |3750000 |I |Owned by ORESA Ventures N.V.|
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1.Title of |2.Con- |3. |4. |5.Number of |6.Date Exer |7.Title and Amount |8.Price|9.Number of |10.|11.Nature of|
Derivative |version |Transaction | Derivative |cisable and | of Underlying |of Deri| Derivative |Dir| Indirect |
Security |or | | | Securities |Expiration | Securities |vative | Securities |ect| Beneficial |
|Exercise| | | Acquired(A) or|Date(Month/ | |Secu | Benefi |(D)| Ownership |
|Price of| | | Disposed of(D)|Day/Year) | |rity | ficially |or | |
|Deriva- | | | |Date |Expir | | | Owned at |Ind| |
|tive | | | | A/|Exer- |ation | Title and Number | | End of |ire| |
|Secu- | | | | | D |cisable |Date | of Shares | | Month |ct | |
|rity | Date |Code|V| Amount | | | | | | |(I)| |
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<S> <C> <C> <C> <C><C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Warrants |$0.65 |9/19/97 |P | | 1250000 |A |9/19/97 |8/1/02 |Common stock|1250000|(1) |2500000 |I |Owned by |
| | | | | | | | | | | | | | Celox S.A. |
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Warrants |$0.65 |9/19/97 |P | | 2500000 |A |9/19/97 |8/1/02 |Common stock|2500000|(1) |3750000 |I |Owned by |
| | | | | | | | | | | | | | ORESA |
| | | | | | | | | | | | | | Ventures NV|
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Explanation of Responses:
(1) These warrants were issued in connection with an equity financing with the
Issuer in the aggregate amount of $1,500,000.
/s/David A. Grossman, Attorney-in-Fact October 9, 1997
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SIGNATURE OF REPORTING PERSON DATE
