-----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, PhKRUGH9ky9rPXA0aJv1gZcrJt7BCd8jOOQTflYg1yPOHhcXrFkT73JymjO99LfB JzfviaJ4riRVRDnQfiXRvw== 0000897069-04-001824.txt : 20041022 0000897069-04-001824.hdr.sgml : 20041022 20041022112625 ACCESSION NUMBER: 0000897069-04-001824 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041020 FILED AS OF DATE: 20041022 DATE AS OF CHANGE: 20041022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOLDBERG LESLIE H CENTRAL INDEX KEY: 0001133888 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07829 FILM NUMBER: 041091034 BUSINESS ADDRESS: STREET 1: BOWL AMERICA IN STREET 2: 6446 EDSALL RD CITY: ALEXANDRIA STATE: VA ZIP: 22313 BUSINESS PHONE: 7039416300 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BOWL AMERICA INC CENTRAL INDEX KEY: 0000013573 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-AMUSEMENT & RECREATION SERVICES [7900] IRS NUMBER: 540646173 STATE OF INCORPORATION: MD FISCAL YEAR END: 0627 BUSINESS ADDRESS: STREET 1: 6446 EDSALL RD CITY: ALEXANDRIA STATE: VA ZIP: 22312 BUSINESS PHONE: 7039416300 MAIL ADDRESS: STREET 1: P O BOX 1288 CITY: SPRINGFIELD STATE: VA ZIP: 22151 4 1 sdc807_ex.xml X0202 4 2004-10-20 0 0000013573 BOWL AMERICA INC BWLA 0001133888 GOLDBERG LESLIE H BOWL AMERICA IN 6446 EDSALL RD ALEXANDRIA VA 22313 1 1 1 0 President Class B Common Stock 2004-10-20 4 W 0 77949 0 A 423048 D Class A Common Stock 2004-10-20 4 W 0 77949 0 A 418134 D Class A Common Stock 3150 I IRA The reported amount has been adjusted to reflect the distribution of 77,949 shares of Class B Common Stock from the C. Edward Goldberg Trust (the "Trust"), effective as of October 20, 2004, following the death of Mr. C. Edward Goldberg. The reporting person was a designated beneficiary as well co-trustee of the Trust and had reported these shares as indirectly owned on previous reports. The remaining 77,949 shares of Class B Common Stock held by the Trust, which had been also reported as indirectly owned by the reporting person, were transferred to Ms. Merle Fabian, a director of Bowl America, Inc. Ms. Fabian was a designated beneficiary and co-trustee of the Trust. The reported amount has been adjusted to reflect the distribution of 77,949 shares of Class A Common Stock from the C. Edward Goldberg Trust (the "Trust"), effective as of October 20, 2004, following the death of Mr. C. Edward Goldberg. The reporting person was a designated beneficiary as well co-trustee of the Trust and had reported these shares as indirectly owned on previous reports. The remaining 77,949 shares of Class A Common Stock held by the Trust, which had been also reported as indirectly owned by the reporting person, were transferred to Ms. Merle Fabian, a director of Bowl America, Inc. Ms. Fabian was a designated beneficiary and co-trustee of the Trust. Leslie H. Goldberg 2004-10-20 -----END PRIVACY-ENHANCED MESSAGE-----