OMB APPROVAL |
OMB Number: 3235-0104 |
Expires: January 31, 2005 |
Estimated average burden hours per response...0.5 |
UNITED STATES FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934, |
| ||||||||||||
1. | Name and Address of Reporting Person* | 2. | Date of Event Requiring Statement
(Month/Day/Year) |
3. | I.R.S. Identification
Number of Reporting Person, if an entity (voluntary) |
|||||||
Kramer Donald J | 12/04/02 | |||||||||||
(Last) (First) (Middle) |
4. |
Issuer Name and Ticker or Trading Symbol |
5. |
Relationship of Reporting Person(s) to Issuer (Check All Applicable) |
||||||||
7841 CocoBay Court | Insignia Systems, Inc. (ISIG) | x Director | o 10% Owner | |||||||||
o Officer (give title below) | ||||||||||||
(Street) | o Other (specify below) | |||||||||||
Naples FL 34108 |
6. | If Amendment, Date of Original (Month/Day/Year) |
|
|||||||||
(City) (State) (Zip) |
7. | Individual or Joint/Group Filing (Check One) |
||||||||||
x Form filed by One Reporting Person | ||||||||||||
o Form filed by More then One Reporting Person | ||||||||||||
|
* | If the form is filed by more than one reporting person, see instruction 5(b)(v). |
Table I Non-Derivative Securities Beneficially Owned | ||||||||||||||
1. | Title of Security (Instr. 4) |
2. | Amount of Securities Beneficially Owned (Instr. 4) |
3. | Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. | Nature of Indirect Beneficial Ownership (Instr. 5) |
|||||||
Table II Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||
1. | Title of Derivative Security (Instr. 4) |
2. | Date Exercisable and Expiration Date (Month/Day/Year) |
3. | Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. | Conversion or Exercise Price of Derivative Security |
5. | Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. | Nature of Indirect Beneficial Ownership (Instr. 5 |
||
Date Exercisable |
Expiration Date |
Title | Amount or Number of Shares |
||||||||||
Non-Qualified S | * | 12/04/12 | Common Stock | 10,000 | $10.44 | D | |||||||
Explanation of Responses: *5,000 shares on 12/4/03 and 5,000 shares on 12/4/04 |
/s/ Donald J. Kramer | 12/11/02 | |
**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). File three copies of this Form, one of which must be manually signed. If space 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. |