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Previous: ASV INC /MN/, 4, 1998-02-09 |
Next: HAMILTON ALEXANDER VARIABLE INSURANCE TRUST, NSAR-B, 1998-02-09 |
FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB Approval
Washington, D.C. 20549 OMB Number 3235-0362
Expires: September
30, 1998
ANNUAL STATEMENT OF CHANGES IN Estimated average
BENEFICIAL OWNERSHIP burden hours per
response . . . 1.0
[ ] Check this box if no longer
subject to Section 16. Filed pursuant to Section 16(a) of
Form 4 or Form 5 the Securities Exchange Act of 1934,
obligations may continue. Section 17(a) of the Public Utility
See Instruction 1(b). Holding Company Act of 1935 or
Section 30(f) of the Investment
[ ] Form 3 Holdings Reported Company Act of 1940
[ ] Form 4 Transactions Reported
<TABLE>
1. Name and Address of 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer
Reporting Person (Check all applicable)
X Director X 10% Owner
DAHL JAMES H. ASV, Inc. (ASVI) ___ Officer (give ___ Other (specify
(Last) (First) (Middle) title below)
below)
3. IRS or Social 4. Statement for
Security Month/Year ____________________________________
1200 Riverplace Blvd., Number of
Suite 920 Reporting December 1997
(Street) Person
(Voluntary)
5. If Amendment, 7. Individual or Joint/Group Filing (Check
Date of Applicable Line)
Original X Form filed by One Reporting Person
Jacksonville Florida (Month/Year) ___ Form filed by More than One Reporting
32207 Person
(City) (State)
(Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security 2.Trans- 3. Trans- 4. Securities 5. Amount of Securities 6. Owner- 7. Nature
(Instr. 3) action action Acquired (A) Beneficially Owned at End ship of In-
Date Code or Disposed of (D) of Issuer's Fiscal Year Form: direct
(Month/ (Instr. (Instr. 3, 4 and (Instr. 3 and 4) Direct Bene-
Day/ 8) 5) (D) or ficial
Year) Indirect Owner-
(I) ship
(Instr. (Instr.
4) 4)
Amount (A) or Price
(D)
<S> <C> <C> <C>
Common Stock 49,200 I By Trust
FBO Son
Common Stock 49,600 I By Trust
FBO
Daughter
Common Stock 296,600 I By Rock
Creek
Partners,
Ltd.
Common Stock 3,000 I By
Spouse's
IRA
Total 398,400
Reminder: Report on a separate line for each class of securities
beneficially owned directly or indirectly. (Over)
* If the form is filed by more than one reporting SEC 2270 (7/96)
person, see instruction 4(b)(v). (Print or Type Responses)
<PAGE>
FORM 5 Table II - Derivative Securities Acquired, Disposed of,
(continued) or Beneficially Owned (e.g., puts, calls, warrants, options,
convertible securities)
1. Title 2. Conver- 3. Trans- 4. Trans- 5. Number 6. Date Exer-
of sion or action action of cisable
Deriv- Exercise Date Code Deriv- and
ative Price of (Month/ (Instr. ative Expiration
Security Derivative Day/Year) 8) Securities Date (Month/
(Instr. Security Acquired Day/Year)
3) (A) or
Disposed
of (D)
(Instr. 3, Date Expira-
4 and 5) Exer- tion
cisable Date
(A) (D)
Common Stock
Options $18.167 12/21/97
Common Stock
Options $18.167 12/21/98
Common Stock
Options $18.167 12/21/99
Common Stock
Options $18.167 12/21/2000
Warrants $ 5.85 05/03/96 08/17/99
Warrants $ 5.85 06/20/96 08/17/99
Convertible
Subordinated
Debenture $24.75 10/08/96 10/15/06
Common Stock
Options $27.50 12/12/97 A A 12/12/98 12/12/02
Common Stock
Options $27.50 12/12/97 A A 12/12/99 12/12/02
Common Stock
Options $27.50 12/12/97 A A 12/12/00 12/12/02
Common Stock
Options $27.50 12/12/97 A A 12/12/01 12/12/02
7. Title and 8. Price of 9. Number of 10. Ownership 11. Nature
Amount of Derivative Derivative of of In-
Underlying Security Securities Derivative direct
Securities (Instr. 5) Beneficially Security; Bene-
(Instr. 3 Owned at End Direct (D) ficial
and 4) of Year or Indirect Owner-
(Instr. 4) (I) (Instr. ship
4) (Instr. 4)
Title Amount or
Number of
Shares
Common 1,875 1 D
Stock
Common 1,875 1 D
Stock
Common 1,875 1 D
Stock
Common 1,875 1 D
Stock
Common 120,000 120,000 I By Rock Creek
Stock Partners Ltd.
Common 15,000 15,000 D
Stock
Common 90,909 1 I By Rock Creek
Stock Partners Ltd.
Common 2,500 1 D
Stock
Common 2,500 1 D
Stock
Common 2,500 1 D
Stock
Common 2,500 1 D
Stock
</TABLE>
**Intentional misstatements or omissions
of facts constitute Federal Criminal /s/ James H. Dahl 02/09/98
Violations. See 18 U.S.C. 1001 and ** Signature of Date
15 U.S.C. 78ff(a). Reporting Person
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 Page 2
form displays a currently valid OEM Number. SEC 2270 (7/96)
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