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-----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, JT5JIlUdZhQVtAPzPasZ/S/xSaW8H7QPnxy0vZo9eL4IufgAwHx/7e7H8bE+MXcs dzIL8HSAH3BcBLAMh8z0fg== 0001020229-02-000008.txt : 20020415 0001020229-02-000008.hdr.sgml : 20020415 ACCESSION NUMBER: 0001020229-02-000008 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011231 FILED AS OF DATE: 20020322 COMPANY DATA: COMPANY CONFORMED NAME: LUCIANO DANIEL H CENTRAL INDEX KEY: 0001020229 OTHER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 242 A WEST VALLEY BROOK ROAD CITY: CALIFON STATE: NJ ZIP: 07880 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AIRTRAX INC CENTRAL INDEX KEY: 0001081372 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 223506376 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-16237 FILM NUMBER: 02582433 BUSINESS ADDRESS: STREET 1: 1616 PENNSYLVANIA AVE 122 CITY: VINELAND STATE: NJ ZIP: 08361 BUSINESS PHONE: 8563278112 MAIL ADDRESS: STREET 1: 1616 PENNSYLVANIA AVE 122 CITY: VINELAND STATE: NJ ZIP: 08361 FORMER COMPANY: FORMER CONFORMED NAME: MAS ACQUISITION IX CORP DATE OF NAME CHANGE: 19990308 5 1 form51231edgar.htm U

U.S. SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 5

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(f) of the Investment Company Act of 1940

[x] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations

may continue. See Instruction 1(b).

[ ] Form 3 Holdings Reported

[ ] Form 4 Holdings Reported

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1. Name and Address of Reporting Person*

Luciano Daniel H

(Last) (First) (Middle)

242A West Valley Brook Road

(Street)

Califon, NJ 07830

(City) (State) (Zip)

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2. Date of Event Requiring Statement (Month/Day/Year)

12/31/01

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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)

N/A

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4. Issuer Name and Ticker or Trading Symbol

Airtrax, Inc.

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5. Relationship of Reporting Person to Issuer

(Check all applicable)

[_] Director [ ] 10% Owner

[_] Officer (give title below) [*] Other (specify below)

Former Director

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

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7. Individual or Joint/Group Filing (Check applicable line)

[*] Form Filed by One Reporting Person

[_] Form Filed by More than One Reporting Person

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Table I -- Non-Derivative Securities Beneficially Owned

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5. &nbs p; 6.

4. Amount of Owner-

Securities Acquired (A) or Securities ship

3. Disposed of (D) Beneficially Form: 7.

Transaction (Instr. 3, 4 and 5) Owned at Direct Nature of

2. Code ------------------------ Issuer’s Fiscal (D) or Indirect

1. Transaction (Instr. 8) (A) Year End Indirect Beneficial

Title of Security Date ------------ Amount or Price (Instr. 3 and (I) Ownership

(Instr. 3) (mm/dd/yy) Code V (D) Instr. 4) (Instr. 4) (Instr. 4)

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common stock 4/01 P 5,000 shs/$0.50 per share* 52,518 D

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* If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v).

Reminder: Report on a separate line for each class of securities beneficially

owned directly or indirectly.

(Print of Type Responses)

(Over)

Table II -- Derivative Securities Beneficially Owned

(e.g., puts, calls, warrants, options, convertible securities)

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& nbsp;

& nbsp; 9.

& nbsp; Number 10.

5. 7. & nbsp; of Ownership

Number of Title and Amount Derivative form

2. Derivative 6. of Underlying 8. Securities of-

Conver- 4. Securities Date Securities Price Bene- Derivative 11.

sion 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Security Nature

or Trans- action or Disposed Expiration Date --------------------- Deriv- Owned Direct of

1. Exercise action Code of (D) (Month/Day/Year) Amount ative at End (D) or Indirect

Title of Price Date (Instr. (Instr. 3, --------------------- or Secur- of Indirect Beneficial

Derivative of (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) Ownership

Security Derivative Day/ --------- ------------ Exer- tion of (Instr. (Instr. (Instr. Instr.

(Instr. 3) Security Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)

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Explanation of Responses:

* The 5,000 shares represented the exercise of director options exercisable at $0.50 per share, and were acquired for services.

/s/ Daniel H. Luciano 3/21/02

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**Signature of Reporting Person 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 provided is insufficient, see Instruction 6 for procedure.

(Print of Type Responses)

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