-----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, WhFnvNdmUhy1m5KxwHT/HRHnQZAGSyNDDP75ObswRCJ9mNPz4dUuq5m+V5zUb8kM XCtbgQVkOPOWkb/XPgtodg== 0000892626-98-000517.txt : 19981215 0000892626-98-000517.hdr.sgml : 19981215 ACCESSION NUMBER: 0000892626-98-000517 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981214 FILED AS OF DATE: 19981214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BELL NATIONAL CORP CENTRAL INDEX KEY: 0000075439 STANDARD INDUSTRIAL CLASSIFICATION: TEXTILE MILL PRODUCTS [2200] IRS NUMBER: 941451828 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-00935 FILM NUMBER: 98769234 BUSINESS ADDRESS: STREET 1: 4209 VINELAND ROAD STREET 2: SUITE J I CITY: ORLANDO STATE: FL ZIP: 32811 BUSINESS PHONE: 4078490290 MAIL ADDRESS: STREET 1: 4209 VINELAND ROAD, SUITE J-1 CITY: ORLANDO STATE: FL ZIP: 32811 FORMER COMPANY: FORMER CONFORMED NAME: PACIFIC COAST HOLDINGS INC DATE OF NAME CHANGE: 19830303 COMPANY DATA: COMPANY CONFORMED NAME: DOOLITTLE DAVID M CENTRAL INDEX KEY: 0001075196 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] OFFICER STATE OF INCORPORATION: IL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: CUES STREET 2: 3600 RIO VISTA AVE CITY: ORLANDO STATE: FL ZIP: 32805 BUSINESS PHONE: 4078490190X211 MAIL ADDRESS: STREET 2: 920 NORTH FRANKLIN STREET SUITE401 CITY: CHICAGO STATE: IL ZIP: 60610 3 1 U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ---------------------------- INITIAL STATEMENT OF | OMB APPROVAL | BENEFICIAL OWNERSHIP OF SECURITIES |--------------------------| | | | OMB NUMBER: 3235-0104 | | EXPIRES: | | February 1, 1994 | Filed pursuant to Section 16(a) of the | ESTIMATED AVERAGE | Securities Exchange Act of 1934, | BURDEN HOURS | Section 17(a) of the Public Utility | PER RESPONSE 0.5 | Holding Company Act of 1935 ---------------------------- or Section 30(f) of the Investment Company Act of 1940 - -------------------------------------------------------------------------- 1. Name and Address of Reporting Person DOOLITTLE DAVID M - -------------------------------------------------------------------------- (Last) (First) (Middle) BELL NATIONAL CORPORATION 3600 RIO VISTA AVENUE SUITE A - -------------------------------------------------------------------------- (Street) ORLANDO FLORIDA 32805 - -------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------- 2. Date of Event Requiring Statement (Month/Day/Year) DECEMBER 4, 1998 - -------------------------------------------------------------------------- 3. IRS OR SOCIAL SECURITY NUMBER OF REPORTING PERSON (VOLUNTARY) - -------------------------------------------------------------------------- 4. Issuer Name and Ticker or Trading Symbol BELL NATIONAL CORPORATION - BLBN - -------------------------------------------------------------------------- 5. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER (CHECK ALL APPLICABLE) ( ) DIRECTOR ( ) 10% OWNER (X) OFFICER TITLE: VICE PRESIDENT, TREASURER ( ) OTHER - -------------------------------------------------------------------------- 6. IF AMENDMENT, DATE OF ORIGINAL (MONTH/DAY/YEAR) - -------------------------------------------------------------------------- 7. INDIVIDUAL OR JOINT/GROUP FILING (CHECK APPLICABLE LINE) (X) FORM FILED BY ONE REPORTING PERSON ( ) 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 | (INSTR. 4) | SECURITIES | FORM DIRECT| BENEFICIAL OWNERSHIP | | BENEFICIALLY| DIRECT (D) | (INSTR.5) | | OWNED | OR INDIRECT| | | (INSTR. 4) | (I) (INSTR.| | | | 5) | - --------------------------------------------------------------------------- NO SECURITIES OWNED ========================================================================== 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) ___________________________ _________________________ Date Exercisable Expiration Date - -------------------------------------------------------------------------- 3. Title and Amount of Securities Underlying Derivative Security (Instr.4) ___________________________ ___________________________ Title Amount of Number of Shares - -------------------------------------------------------------------------- 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) ========================================================================== EXPLANATION OF RESPONSES: /s/ Jonathan A. Bohlen His: Attorney-in-Fact DECEMBER 14, 1998 ____________________________________________ ___________________ **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. POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB NUMBER. ========================================================================== -----END PRIVACY-ENHANCED MESSAGE-----