-----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, Guw/m1TOrZXKLaj6jBSd+X3uyWhNrijHMJIzbBLC5uPfh4MhGKepWuXE7DfPxt1F +veJVgn1PXc0sr9Ra2NlJA== 0001042645-03-000058.txt : 20030501 0001042645-03-000058.hdr.sgml : 20030501 20030501154523 ACCESSION NUMBER: 0001042645-03-000058 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030501 FILED AS OF DATE: 20030501 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: LEVINSON DANIEL CENTRAL INDEX KEY: 0001116164 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: ONE CHURCH STREET SUITE 302 CITY: ROCKVILLE STATE: MD ZIP: 20850 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PUROFLOW INC CENTRAL INDEX KEY: 0000100591 STANDARD INDUSTRIAL CLASSIFICATION: GENERAL INDUSTRIAL MACHINERY & EQUIPMENT, NEC [3569] IRS NUMBER: 131947195 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-05622 FILM NUMBER: 03676866 BUSINESS ADDRESS: STREET 1: 16559 SATICOY STREET CITY: VAN NUYS STATE: CA ZIP: 91406 BUSINESS PHONE: 8187561388 MAIL ADDRESS: STREET 1: 16559 SATICOY STREET STREET 2: 1631 TENTH ST CITY: VAN NUYS STATE: CA ZIP: 91406 FORMER COMPANY: FORMER CONFORMED NAME: ULTRA DYNAMICS CORP DATE OF NAME CHANGE: 19830522 3 1 levinform3-52003.htm FORM 3 Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

OMB APPROVAL

 

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

OMB Number: 3235-0104
Expires: January 31, 2005
Estimated average burden
hours per response. . .0.5


1. Name and Address of Reporting Person*

Levinson                Daniel

2. Date of Event
Requiring Statement
Month/Day/Year
05/01/03

4. Issuer Name and Ticker or Trading Symbol
Puroflow Incorporated.  PFLW

(Last)               (First)             (Middle)

8 Wright Street
 

3. I.R.S. Identification
Number of Reporting
Person, if an entity
(voluntary)

 

5. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
X Director                        X 10% Owner
   Officer                            Other
(give title below)              (specify below)

                                                                        

 6. If Amendment,
Date of Original
(Month/Day/Year)
 

(Street)

Westport                     CT              06880

 7. Individual or Joint/Group Filing
(Check Applicable Line)
X Form filed by One Reporting Person
    Form filed by More than One Reporting Person

(City)                  (State)             (Zip)

Table I -- Non-Derivative Securities Beneficially Owned

1. Title of Security
(Instr. 4)

2. Amount of Securities Beneficially Owned
(Instr. 4)

3. Ownership Form:
Direct (D) or Indirect (I)
(Instr. 5)

4. Nature of Indirect Beneficial Ownership
(Instr. 5)

Common Stock

3,000              

I

custodial

Common Stock

248,068              

I

by MSR I SBIC, L.P. - partnership

Common Stock

64,516              

I

by MSR I SBIC, L.P. - partnership
       
       
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5(b)(v).

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number
FORM 3 (continued)

Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative Security
(Instr. 4)

2. Date Exercisable
and Expiration Date
(Month/Day/ Year)

3. Title and Amount of Securities
Underlying Derivative Security
(Instr. 4)

4. Conversion or
Exercise Price of
Derivative Security

5. Ownership Form
of Derivative
Security:
Direct (D)
or Indirect (I)
(Instr. 5)

6. Nature of Indirect Beneficial Ownership
(Instr. 5)

Date
Exercisable

Expiration
Date

Title          

Amount or
Number of
Shares

Warrant 4/29/03 12-31-12 Common Stock 50,000

7.75

  I

 by Puroflow Incorporated - Corporation

               
               
               
               
               

Explanation of Responses:


 

By:      /s/Daniel Levinson                 
**Signature of Reporting Person

     05/01/03     
Date

**Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed.
          If space is insufficient, See Instruction 6 for procedure.

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.

 

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