-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, VrfFBnoeAzRvXjTyLkA38NYqOIQM2pILQeCvEW/oI+fYJNqx9YDggQ3uKyXIbfRk xNSDu4AZwUHTUGTfxY1c/Q== 0000743530-03-000009.txt : 20030214 0000743530-03-000009.hdr.sgml : 20030214 20030214151453 ACCESSION NUMBER: 0000743530-03-000009 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20030214 GROUP MEMBERS: CHARLOTTE H STAFFORD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AMES NATIONAL CORP CENTRAL INDEX KEY: 0001132651 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 421039071 STATE OF INCORPORATION: IA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-78166 FILM NUMBER: 03567004 BUSINESS ADDRESS: STREET 1: PO BOX 846 CITY: AMES STATE: IA ZIP: 50010 BUSINESS PHONE: 5152326251 MAIL ADDRESS: STREET 1: PO BOX 846 CITY: AMES STATE: IA ZIP: 50010 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: STAFFORD ROBERT W CENTRAL INDEX KEY: 0001168438 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: PO BOX 846 CITY: AMES STATE: IA ZIP: 50010 BUSINESS PHONE: 5156633058 MAIL ADDRESS: STREET 1: PO BOX 846 CITY: AMES STATE: IA ZIP: 50010 SC 13G/A 1 amesbobcharl.txt SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 1)* AMES NATIONAL CORPORATION ------------------------- (Name of Issuer) COMMON STOCK ------------------------------ (Title of Class of Securities) 031001100 -------------- (CUSIP Number) December 31, 2002 ------------------------------------------------------- (Date of Event Which Requires Filing of this Statement) Check the appropriate box to designate the rule to which this Schedule is filed: [_] Rule 13d-1(b) [X] Rule 13d-1(c) [_] Rule 13d-1(d) * The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosure provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). 1 CUSIP No. 031001100 SCHEDULE 13G 1. Name of Reporting Person Robert W. Stafford I.R.S. Identification No. of Above Person (entities only) Not Applicable 2. Check the appropriate box if a member of a group (a) ______ (b) ___X__ 3. SEC Use Only 4. Citizenship or Place of Organization Iowa NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH: 5. Sole Voting Power 177,432 6. Shared Voting Power 157,053 7. Sole Dispositive Power 177,432 8. Shared Dispositive Power 157,053 9. Aggregate Amount Beneficially Owned by Each Reporting Person 334,485 10. Check box if the aggregate amount in Row (9) excludes certain shares 11. Percent of Class Represented by Amount in Row 9 10.7% 12. Type of Reporting Person IN 2 1. Name of Reporting Person Charlotte H. Stafford I.R.S. Identification No. of Above Person (entities only) Not Applicable 2. Check the appropriate box if a member of a group (a) ________ (b) ____X___ 3. SEC Use Only 4. Citizenship or Place of Organization Texas NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH: 5. Sole Voting Power 11,680 6. Shared Voting Power 157,053 7. Sole Dispositive Power 11,680 8. Shared Dispositive Power 157,053 9. Aggregate Amount Beneficially Owned by Each Reporting Person 168,733 10. Check box if the aggregate amount in Row (9) excludes certain shares 11. Percent of Class Represented by Amount in Row 9 5.4% 12. Type of Reporting Person IN 3 ITEM 1(a). NAME OF ISSUER. Ames National Corporation ITEM 1(b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES. P.O. Box 846 Ames, IA 50010 ITEM 2(a). NAME OF PERSON FILING. This filing is made on behalf of Robert W. Stafford and Charlotte H. Stafford. Mr. Stafford and Ms. Stafford each disclaim membership in a group. Mr. Stafford disclaims beneficial ownership of the 11,680 shares over which Ms. Stafford has sole voting and dispositive power. Ms. Stafford disclaims beneficial ownership of the 177,432 shares over which Mr. Stafford has sole voting and dispositive power. Mr. Stafford and Ms. Stafford are co-trustees of two trusts with aggregate holdings of 157,053 shares over which Mr. Stafford and Ms. Stafford have shared voting and dispositive power. Mr. Stafford, however, disclaims any pecuniary interest in any of the shares held by the trusts. ITEM 2(b). ADDRESS OF THE PRINCIPAL OFFICES OR RESIDENCE: Robert W. Stafford's business address is P.O. Box 846, Ames, Iowa 50010 and Charlotte H. Stafford's residence address is 9701 Meyer Forest Drive, Apt. 12202, Houston, Texas 77096-4324. 4 ITEM 2(c). CITIZENSHIP. Robert W. Stafford - Iowa Charlotte H. Stafford - Texas ITEM 2(d). TITLE OF CLASS OF SECURITIES. Common Stock. ITEM 2(e). CUSIP NUMBER. 031001100 ITEM 3. IF THE STATEMENT IS BEING FILED PURSUANT TO SECTION 240.13d-1(b), CHECK WHETHER THE PERSON FILING IS A: Not Applicable ITEM 4. OWNERSHIP. As of December 31, 2002, Robert W. Stafford and Charlotte H. Stafford, collectively, beneficially owned an aggregate of 346,165 shares of the common stock of Ames National Corporation, which represented approximately 11.06 percent of the outstanding shares. Mr. Stafford and Ms. Stafford each disclaim membership in a group, and their individual share ownership and percentages and information regarding the manner in which the shares are beneficially owned are set forth in their respective cover pages. Mr. Stafford disclaims beneficial ownership of the 11,680 shares over which Ms. Stafford has sole voting and dispositive power. Ms. Stafford disclaims beneficial ownership of the 177,432 shares over which Mr. Stafford has sole voting and dispositive power. Mr. Stafford and Ms. Stafford are co-trustees of two trusts with aggregate holdings of 157,053 shares over which Mr. Stafford and Ms. Stafford have shared voting and dispositive power. Mr. Stafford, however, disclaims any pecuniary interest in any of the shares held by the trust. ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS. Not Applicable ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON. Not Applicable ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY. Not Applicable ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP. Not Applicable ITEM 9. NOTICE OF DISSOLUTION OF A GROUP. Not Applicable ITEM 10. CERTIFICATION. By signing below, I certify that, to the best of my knowledge and belief, the securities referred to above were acquired in the ordinary course of business and were not acquired for the purpose of and do not have the effect of changing or influencing the control of the issuer of such securities and were not acquired in connection with or as a participant in any transaction having such purpose or effect. 5 SIGNATURE After reasonable inquiry and to the best of its knowledge and belief, the undersigned certifies that the information set forth in this statement is true, complete and correct. BY: /s/ Robert W. Stafford --------------------------- Name: Robert W. Stafford -------------------------- .. BY: /s/ Charlotte H. Stafford --------------------------- Name: Charlotte H. Stafford -------------------------- Date: February 14, 2003 6 EXHIBIT A JOINT FILING AGREEMENT Robert W. Stafford and Charlotte H. Stafford agree that the Schedule 13G to which this Joint Filing Agreement is attached, relating to the Common Stock of Ames National Corporation, is filed on behalf of each of them. BY: /s/ Robert W. Stafford --------------------------- Name: Robert W. Stafford ------------------------- .. BY: /s/ Charlotte H. Stafford -------------------------- Name: Charlotte H. Stafford ------------------------- Date: February 14, 2003 7 -----END PRIVACY-ENHANCED MESSAGE-----