0000910680-05-000107.txt : 20120703 0000910680-05-000107.hdr.sgml : 20120703 20050202145402 ACCESSION NUMBER: 0000910680-05-000107 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20050202 DATE AS OF CHANGE: 20050202 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: JACLYN INC CENTRAL INDEX KEY: 0000052969 STANDARD INDUSTRIAL CLASSIFICATION: LEATHER & LEATHER PRODUCTS [3100] IRS NUMBER: 221432053 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-13465 FILM NUMBER: 05568983 BUSINESS ADDRESS: STREET 1: 635 59TH STREET CITY: WEST NEW YORK STATE: NJ ZIP: 07093 BUSINESS PHONE: 2018689400 MAIL ADDRESS: STREET 1: 5801 JEFFERSON STREET CITY: WEST NEW YORK STATE: NJ ZIP: 07093 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: LEVY BONNIE SUE CENTRAL INDEX KEY: 0001006841 IRS NUMBER: 142388915 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 635 59TH STREET CITY: WEST NEW YORK STATE: NJ ZIP: 07093 BUSINESS PHONE: 2018689400 MAIL ADDRESS: STREET 1: 635 59TH ST W CITY: W NEW YORK STATE: NY ZIP: 07093 SC 13G/A 1 sc13gabslevy123104.txt SCHEDULE 13 G/A ----------------------------- OMB APPROVAL ----------------------------- OMB Number 3235-0145 Expires: December 31, 2005 Estimated average burden hours per response .......11 ----------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G/A UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 26)* Jaclyn, Inc. -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, $1.00 par value per share -------------------------------------------------------------------------------- (Title of Class of Securities) 469772 10 7 ------------------------------------------------------------------------------ (CUSIP Number) December 31, 2004 ----------------------------------------------------------- (Date of Event which requires filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Statement is filed: [ ] Rule 13d-1(b) [ ] Rule 13d-1(c) [x] 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 disclosures provided in a prior cover page. The information required in 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). CUSIP No. 469772 10 7 13G Page 2 of 3 Pages -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Bonnie Sue Levy -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [ ] -------------------------------------------------------------------------------- 3 SEC USE ONLY -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States -------------------------------------------------------------------------------- NUMBER OF 5 SOLE VOTING POWER SHARES BENEFICIALLY 0 OWNED BY ------------------------------------------------------------- EACH 6 SHARED VOTING POWER REPORTING PERSON 0 WITH ------------------------------------------------------------- 7 SOLE DISPOSITIVE POWER 213,968 ------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 0 -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 213,968 -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* (See Instructions) [ ] -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 8.2% -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT CUSIP No. 469772 10 7 13G Page 3 of 3 Pages Except as to Item 4, no change has occurred with respect to the answer to any items of this Schedule from the information last reported in respect of such item. Item 4. Ownership. As of December 31, 2004: (a) Amount beneficially owned: 213,968 shares of Common Stock. This amount includes 6,164 shares allocated to Mrs. Levy's account under the Jaclyn, Inc. Employee Stock Ownership Plan (b) Percent of Class:8.2% (c) Number of shares as to which such person has: (i) sole power to vote or direct the vote: none (ii) shared power to vote or direct the vote: none (iii) sole power to dispose or direct the disposition of: 213,968 (iv) shared power to dispose or direct the disposition of: none SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. February 1, 2005 --------------------------------------------- Date /s/ Bonnie Sue Levy --------------------------------------------- Signature Bonnie Sue Levy --------------------------------------------- Name/Title