-----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, SKQCwgGFpVKAbrnoo0B9olR2XX9HUMHMj84ivax7rsOekQ4NzgCGrctRTDhi6Wbu m+fl5prktlw+kBxjsGiySA== 0000918545-00-000017.txt : 20000510 0000918545-00-000017.hdr.sgml : 20000510 ACCESSION NUMBER: 0000918545-00-000017 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000501 FILED AS OF DATE: 20000509 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BALTIC INTERNATIONAL USA INC CENTRAL INDEX KEY: 0000918545 STANDARD INDUSTRIAL CLASSIFICATION: ARRANGEMENT OF TRANSPORTATION OF FREIGHT & CARGO [4731] IRS NUMBER: 760336843 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-26558 FILM NUMBER: 622326 BUSINESS ADDRESS: STREET 1: 5151 SAN FELIPE STREET 2: SUITE 1661 CITY: HOUSTON STATE: TX ZIP: 77056 BUSINESS PHONE: 7139619299 MAIL ADDRESS: STREET 1: 5151 SAN FELIPE STREET 2: SUITE 1661 CITY: HOUSTON STATE: TX ZIP: 77056 COMPANY DATA: COMPANY CONFORMED NAME: NICOL L T CENTRAL INDEX KEY: 0001106600 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: PO BOX 1067 CITY: CROCKETT STATE: TX ZIP: 75835 BUSINESS PHONE: 7139619299 MAIL ADDRESS: STREET 1: PO BOX 1067 CITY: CROCKETT STATE: TX ZIP: 75835 3 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 1. Name and Address of Reporting Person JONAS AF JOCHNICK PLACE FLAGEY 7, BTE 7 1050 BRUSSELS BELGIUM 2. Date of Event Requiring Statement (Month/Day/Year) AUGUST 15 1997 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Issuer Name and Ticker or Trading Symbol BALTIC INTERNATIONAL USA, INC. BISA 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director (X) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 6. If Amendment, Date of Original (Month/Day/Year) 7. Individual or Joint/Group Filing (Check Applicable Line) ( ) Form filed by One Reporting Person (X) Form filed by More than One Reporting Person
___________________________________________________________________________________________________________________________________ Table I -- Non-Derivative Securities Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. Amount of |3. Ownership |4. Nature of Indirect | | Securities | Form: | Beneficial Ownership | | Beneficially | Direct(D) or | | | Owned | Indirect(I) | | ___________________________________________________________________________________________________________________________________| COMMON STOCK |1250000 |I | By Celox S.A. | - -----------------------------------------------------------------------------------------------------------------------------------| COMMON STOCK |1250000 |I | By ORESA Ventures N.V. | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Date Exer- |3.Title and Amount | |4. Conver-|5. Owner- |6. Nature of Indirect | Security | cisable and | of Underlying | |sion or |ship | Beneficial Ownership | | Expiration | Securities | |exercise |Form of | | | Date(Month/ |-----------------------|---------|price of |Deriv- | | | Day/Year) | |Amount |deri- |ative | | | Date | Expira- | |or |vative |Security: | | | Exer- | tion | Title |Number of|Security |Direct(D) or | | | cisable | Date | |Shares | |Indirect(I) | | ___________________________________________________________________________________________________________________________________| Warrants |8/15/97 |8/1/02 |Common stock |1250000 |$0.65 |I |By Celox S.A. | - -----------------------------------------------------------------------------------------------------------------------------------| Warrants |8/15/97 |8/1/02 |Common stock |1250000 |$0.65 |I |By Oresa Ventures N.V. | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: SIGNATURE OF REPORTING PERSON DAVID A. GROSSMAN, ATTORNEY-IN-FACT DATE AUGUST 22, 1997 -----END PRIVACY-ENHANCED MESSAGE-----