FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of |
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£ |
Check this box if no longer |
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£ |
Form 3 Holdings Reported |
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£ |
Form 4 Transactions Reported |
1. Name and Address of Reporting Person* |
2. Issuer Name and Tickler or Trading Symbol Synalloy Corporation SYNC |
6. Relationship of Reporting Person(s) to Issuer |
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X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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(Last) (First) (Middle) |
3. I.R.S. Identification Number of |
4. Statement for Month/Year |
7. Individual or Joint/Group Filing (Check Applicable Line) |
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5. If Amendment, Date of |
X |
Form filed by One Reporting Person |
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(Street) |
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Form filed by More than One Reporting Person |
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(City) (State) (Zip) |
Table I ¾ Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of Security |
2. Transaction Date |
3. Transaction |
4. Securities Acquired (A) |
5. Amount of Securities |
6. OwnershipForm: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature ofIndirect Beneficial Ownership (Instr. 4) |
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Amount |
(A) or |
Price |
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Common Stock |
53,928 |
D |
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Common Stock |
7,065 |
I |
*Spouse |
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Common Stock |
8,000 |
I |
Irrevocable Trust |
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Common Stock |
19,000 |
I |
*By Trust (1) |
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* If the form is filed by more than one reporting person, see instruction 4(b)(v).
FORM 5 (continued) |
Table II `
Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of |
2. Conversion |
3. Transaction (Month/Day/Year) |
4. Transaction |
5. Number of |
6. Date Exercisable |
7. Title and Amount |
8. Price of |
9. Number of |
10. Ownership |
11. Nature of |
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(A) |
(D) |
Date |
Expiration |
Title |
Amount or |
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1994 Non-Employee Directors Stock Option Plan |
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1,500 |
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Common Stock |
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13,500 |
D |
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Explanation of Responses: *I expressly disclaim beneficial ownership of these securities and filing this report shall not be construed as an admission of my beneficial ownership thereof for purposes of Section 16 of the Securities Act, or otherwise. |
Cheryl C. Carter |
January 6, 2003 |
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**Signature of Reporting Person /s/ Cheryl C. Carter, Power of Attorney |
Date |
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** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. |
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See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
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Note: |
File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |