-----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, FPKTgF0KfpuImkLIj6tsYwtd7etZL14KecLmGPSnsBJXTJc15GTTvWi44tLSZAE9 uCeu5gb2UzDTxUyK1TH3yA== 0000935703-96-000017.txt : 19961108 0000935703-96-000017.hdr.sgml : 19961108 ACCESSION NUMBER: 0000935703-96-000017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19961107 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: DOLLAR TREE STORES INC CENTRAL INDEX KEY: 0000935703 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331] IRS NUMBER: 541387365 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25464 FILM NUMBER: 96656011 BUSINESS ADDRESS: STREET 1: 2555 ELLSMERE AVE STREET 2: NORFOLK COMMERCE PARK CITY: NORFOLK STATE: VA ZIP: 23513 BUSINESS PHONE: 8048574600 MAIL ADDRESS: STREET 1: P O BOX 2500 CITY: NORFOLK STATE: VA ZIP: 23501-2500 COMPANY DATA: COMPANY CONFORMED NAME: WHITE STEPHEN W CENTRAL INDEX KEY: 0001023820 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: P O BOX 2500 CITY: NORFOLK STATE: VA ZIP: 23501-2500 BUSINESS PHONE: 7578574600 4 1
- ---------------- U.S. SECURITIES AND EXCHANGED COMMISION ---------------------------- |F O R M 4| Washington, D.C. 20549 | OMB APPROVAL | - ---------------- |--------------------------| STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |OMB Number 3235-0287| [ ] Check this box if |Expires: September 30,1998| no longer Subject Filed pursuant to Section 16(a) of the Securities Exchanged Act of 1934, |Estimated ave. burden | to Section 16. Section 17(a) of the Public Utility Holding Company Act of 1935 or |hours per response.....0.5| Section 30(f) of the Investment Company Act 1940 ---------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ |1.Name and Address of Reporting Person* |2.Issuer Name and Ticker or Trading Symbol |6.Relationship of Reporting Person to | | | | Issuer (Check all Applicable) | |White Stephen W |DOLLAR TREE STORES, INC. (DLTR) | | | | | Director 10% Owner | |----------------------------------------|------------------------------------------------|--- --- | | (Last) (First) (MI)|3.IRS or Soc. Sec. No. |4.Statement for Month/ | Officer Other | | | of Reporting Person | Year |---(give title below) ---(Specify below)| | 2555 ELLSMERE AVENUE | (Voluntary) | | | | | | October 1996 | | | | | | Vice President, Logistics | |----------------------------------------| |------------------------|----------------------------------------| | (Street) | |5.If Amendment, Date of |7. Individual or Joint/Group Filing | | | ###-##-#### | Original (Month/Year) | (Check Applicable Line) | | | | | | |NORFOLK VA 23513 | | | X Form filed by One Reporting Person | | | | |--- | | | | | Form filed by More than One | | | | |--- Reporting Person | |----------------------------------------------------------------------------------------------------------------------------------| | (City) (State) (Zip) | | TABLE I - Non-Derivative Securities Acquired, Disposed of or Beneficially Owned | |----------------------------------------------------------------------------------------------------------------------------------| |1.Title of Security |2.Transac- |3.Trans. |4.Security Acquired (A) or |5.Amount of |6. |7.Nature of Indirect| | (Instr. 3) | tion Date | Code | Disposed of (D) | Securities |Own.| Beneficial | | |(Mon/Day/Yr)|(Instr.8)| (Instr. 3, 4 & 5) | Beneficially |Form| Ownership | | | |---------|-------------------------------| Owned at End of|(D) | (Instr. 4) | | | | | | |(A) | | Month |or | | | | |Code| V | Amount |(D) | Price | (Instr. 3 & 4) |(I) | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | |Common Stock | 10/25/1996 | M | | 3825 | A | $10.0000| | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| |Common Stock | 10/25/1996 | S | | 3825 | D | $40.0000| 300 | D | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class securities owned directly or indirectly. SEC 1474 (7-96) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). PAGE: 1 OF 2
FORM 4 (continued) TABLE II - Derivative Securities Acquired, Disposed of, Beneficially Owned (e.g., puts, calls, warrants, options, convertible security) - ------------------------------------------------------------------------------------------------------------------------------------ |1.Title of|2.Conver-|3. |4.Tran- |5.Number of |6.Date |7.Title and Amount |8.Price of|9.Number |10. |11.Nature | |Derivative|sion or |Trans| saction| Derivative |Exercisable| of Underlying |Derivative| of |Own.| of | |Security |Exercise |Date | Code | Securities |and | Securities |Security |Derivative|Form|Indirect | |(Instr. 3)|Price of |(Mon/|(Instr.8)| Acquired (A) or |Expiration | (Instr. 3 & 4) |(Instr. 5)|Securities|of |Beneficial| | |Deriva- | Day/| | Disposed of (D) |Date | | |Benefi- |Deri|Ownership | | |tive |Year)| | (Instr. 3, 4 & 5) |(Month/Day/| | |cially |Sec.|(Instr. 4)| | |Security | | | | Year) | | |Owned at |Dir.| | | | | | | |-----------|---------------------| |End of |(D) | | | | | | | | | | |Amount or | |Month |or | | | | | |---------|---------------------|Date |Exp. | Title |Number of | |(Instr. 4)|Ind.| | | | | |Code| V | (A) | (D) |Exbl.|Date | |Shares | | |(I) | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | |Stock Opti| $10.0000|10/25| M | | | 3825| | |Common Sto| 3825| | 7425| D | | |on | | 1996| | | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | (01)| (02)| | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (01) Options vest over 3 years. Optionee may purchase up to 34% of underlying shares after 3/5/96, up to 68% of underlying s hares after 3/5/97, and up to 100% of underlying shares after 3/5/98. (02) Option lapses upon termination of employment (with certain grace periods) or 3/5/2005, whichever is greater. **Intentional misstatements or omissions of facts constitute Federal /s/Stephen W. White 11/07/1996 Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------------------ ---------- **Signature of Reporting Person Date Note: File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. SEC 1474 (7-96) Potential persons who are to respond to the collections of information contained in this form are not required to respond unless the form displays a currently valid OMD Number White, Stephen DOLLAR TREE STORES, INC. OCT-1996 PAGE: 2 OF 2
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