FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
[ ] Check box if no longer subject
to Section 16. Form 4 or Form 5 ANNUAL STATEMENT OF CHANGES
obligations may continue. See IN BENEFICIAL OWNERSHIP
Instructions 1(b).
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
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1. Name and Address of Reporting Person
Coskey Hulda L.
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(Last) (First) (Middle)
600 Century Plaza Dr Building 140
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(Street)
Houston, TX 77073
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Industrial Data Systems Corporation ("IDDS")
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
1996
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] 10% Owner
[X] Director
[X] Officer (give title below)
[ ] Other (specify below)
Chief Financial Officer
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V.P. Finance
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TABLE I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
<TABLE>
<S> <C>
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1. 2. 3. 4. 5. 6. 7.
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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) ---------------------------- Fiscal Year Indirect Beneficial
Security Day/ ---------- Amount (A) or Price (Instr. (I) Ownership
(Instr. 3) Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4)
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Common Stock, $.001 par value I 4,750,000 D
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Print or Type Responses)
<PAGE>
Page 2
FORM 5 (continued)
TABLE II--Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g. puts, calls, warrants, options, convertible securities)
<TABLE>
<S> <C>
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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
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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)
- ---------- -------- -------- ---- --- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ----------
</TABLE>
Explanation of Responses:
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/s/
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** 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 procedure.
