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- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION -----------------------------
FORM 5 WASHINGTON, D.C. 20549 OMB APPROVAL
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/ / CHECK BOX IF NO LONGER ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0362
SUBJECT TO SECTION 16. EXPIRES: SEPTEMBER 30, 1998
FORM 4 OR FORM 5 OBLI- Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN
GATIONS MAY CONTINUE. Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 1.0
SEE INSTRUCTION 1(b). Section 30(f) of the Investment Company Act of 1940 -----------------------------
/ / FORM 3 HOLDINGS REPORTED
/ / FORM 4 TRANSACTIONS REPORTED
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
Teltone Corp TTNC X Director X 10% Owner
Anderson Charles L ###-##-#### June 1999 ---- ----
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(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- title ---- below)
Number of Reporting Month/Year below)
Person (Voluntary)
PO Box 68 June 1998 --------------------------
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(Street) 5. If Amendment, 7. Individual or Joint/Group Reporting
Date of Original (check applicable line)
(Month/Year) X Form Filed by One Reporting Person
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Form filed by More than One
Reporting Person
Stanwood, WA 98292-0068 ---
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(City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) or 5. Amount of 6. Owner- 7. Nature of
(Instr. 3) action tion Disposed of (D) Securities ship Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial
(Instr. 8) Owned at Direct Ownership
(Month/ end of (D) or (Instr. 4)
Day/ ------------------------------ Issuer's Indirect
Year) Amount (A) or Price Fiscal Year (I)
(D) (Instr. 3 (Instr. 4)
and 4)
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Common Stock 825,363 D
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Common Stock 13,985 I (Profit Sharing Trust)
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Common Stock 66,400 I (Family Foundation)
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Preferred Stock 65,934 D
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Preferred Stock 50,000 I (Family Foundation)
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*If the form is filed by more than one reporting person, see instruction 4(b)(v). (Over)
SEC 2270 (7/97)
POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTION OF INFORMATION
CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS
A CURRENTLY VALID OMB CONTROL NUMBER.
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FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative Security 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer-
(Instr. 3) sion of action action Derivative cisable and
Exercise Date Code Securities Ac- Expiration
Price of (Month/ (Instr. 8) quired (A) or Date
Deriv- Day/ Disposed of (Month/Day/
ative Year) (D) Year)
Security (Instr. 3, 4, and 5)
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Date Expir-
---------------------- Exer- ation
cisable Date
(A) (D)
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Option (right to buy) V (1) 04/15/02
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7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Na-
lying Securities of of Deriv- ship ture of
(Instr. 3 and 4) Deriv- ative of Indirect
ative Secur- Deriv- Bene-
Secur- ities ative ficial
ity Bene- Secur- Owner-
(Instr. ficially ity: ship
5) Owned Direct (Instr. 4)
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of Year or In-
Amount or (Instr. 4) direct
Title Number of (I)
Shares (Instr. 4)
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common 40,000 .50 32,500 D
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Explanation of Responses: (1) 1996 Nonemployee Director's Stock Option Plan. Granted 40,000 shares on 4/15/96, approved by
shareholders on 10/29/96. Vesting over 4 year period with 1/48th of the option vesting on the first day of each month beginning
on the first day of the month following grant date and continuing each month thereafter until fully vested.
/s/ Charles L. Anderson 8/12/99
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**Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date
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.
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the
form displays a currently valid OMB number. Page 2
SEC 2270 (7-97)
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