U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
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
[x] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Holdings Reported
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1. Name and Address of Reporting Person*
Luciano Daniel H
(Last) (First) (Middle)
242A West Valley Brook Road
(Street)
Califon, NJ 07830
(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
12/31/01
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
N/A
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4. Issuer Name and Ticker or Trading Symbol
Airtrax, Inc.
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [ ] 10% Owner
[_] Officer (give title below) [*] Other (specify below)
Former Director
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing (Check applicable line)
[*] Form Filed by One Reporting Person
[_] Form Filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
3. Disposed of (D) Beneficially Form: 7.
Transaction (Instr. 3, 4 and 5) Owned at Direct Nature of
2. Code ------------------------ Issuers Fiscal (D) or Indirect
1. Transaction (Instr. 8) (A) Year End Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 and (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) Instr. 4) (Instr. 4) (Instr. 4)
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common stock 4/01 P 5,000 shs/$0.50 per share* 52,518 D
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* If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print of Type Responses)
(Over)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9.
Number 10.
5. 7. of Ownership
Number of Title and Amount Derivative form
2. Derivative 6. of Underlying 8. Securities of-
Conver- 4. Securities Date Securities Price Bene- Derivative 11.
sion 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Security Nature
or Trans- action or Disposed Expiration Date --------------------- Deriv- Owned Direct of
1. Exercise action Code of (D) (Month/Day/Year) Amount ative at End (D) or Indirect
Title of Price Date (Instr. (Instr. 3, --------------------- or Secur- of Indirect Beneficial
Derivative of (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) Ownership
Security Derivative Day/ --------- ------------ Exer- tion of (Instr. (Instr. (Instr. Instr.
(Instr. 3) Security Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Explanation of Responses:
* The 5,000 shares represented the exercise of director options exercisable at $0.50 per share, and were acquired for services.
/s/ Daniel H. Luciano 3/21/02
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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.
(Print of Type Responses)