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OMB APPROVAL
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- -------- OMB Number: 3235-0104
FORM 3 Expires: April 30, 1997
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hours per response .... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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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<S> <C> <C> <C>
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1. Name and Address of Reporting Person 2. Date of Event Requiring 4. Issuer Name and Ticker or
Apollo Investment Fund III, L.P. Statement Trading Symbol
- ------------------------------------ (Month/Day/Year) DOMINICK'S SUPERMARKETS, INC. DFF
(Last) (First) (Middle) 10/28/96 ----------------------------------------------------------
c/o Apollo Advisors II, L.P. ---------------------------- 5. Relationship of Reporting 6. If Amendment, Date
Two Manhattanville Road 3. IRS or Social Security Person to Issuer of Original
- ------------------------------------ Number of Reporting (Check all applicable) (Month/Day/Year)
(Street) Person (Voluntary) Director X 10% Owner
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Purchase, New York 10577 ---------------------------- ----- Officer ---- Other (specify
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(City) (State) (Zip) ---------------------------
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Common Stock(1) (3) (5) 1,699,979(1) (3) (5) D(1) (3) (5)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses) SEC 1473 (8/92)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Class B Common Stock(2) (4) (5) Immed N/A Common Stock 1,227,611(2) 1 for 1 D
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Explanation of Responses:
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1. Includes 92,936 shares of Common Stock of Dominick's Supermarkets, Inc. APOLLO INVESTMENT FUND III, L.P.
(the "Issuer") owned by Apollo Overseas Partners III, L.P. ("Overseas III") and
57,571 shares of Common Stock owned by Apollo (U.K.) Partners III, L.P. ("UK By: Apollo Advisors II, L.P., its General
III"). Apollo Advisors II, L.P. is the general partner of the Reporting Person, Partner
Overseas III and UK III. The Reporting Person disclaims beneficial ownership of By: Apollo Capital Management II, Inc.,
all securities owned by Overseas III and UK III, and this report shall not be its General Partner
deemed an admission that the Reporting Person is the beneficial owner of such By: /s/ Michael D. Weiner/Vice President
securities for purposes of Section 16 or for any other purpose. ----------------------------------------
Signature Line for
2. Includes 67,100 shares of Class B Common Stock of the Issuer owned by Apollo Investment Fund III, L.P.
Overseas III and 41,571 shares of Class B Common Stock owned by UK III. The
Reporting Person disclaims beneficial ownership of all securities owned by 10/28/96
Overseas III and UK III, and this report shall not be deemed an admission that ---------
the Reporting Person is the beneficial owner of such securities for purposes of Date
Section 16 or for any other purpose.
3. The Reporting Person's beneficial ownership excludes 1,699,979 shares of Common Stock owned by Apollo Investment Fund, L.P.
("AIF"). The general partner of the Reporting Person and the general partner of AIF are affiliated entities.
4. The Reporting Person's beneficial ownership excludes 1,227,612 shares of Class B Common Stock owned by AIF.
5. The Riporting person disclaims beneficial ownership of all secutities owned by AIF, and this report shall not be deemed an
admission that the Reporting Person is the beneficial owner of such shares for purposes of Section 16 of for any other purpose.
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