-----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, NpIVVTdZojHNedxEBlcAOuXiQHP5tVjQGG+OtQKQRDhk0YLkhMVMjAyccEUKJcuW v5uMbnyi6ytkjNRErw4pxA== 0000950152-03-001305.txt : 20030207 0000950152-03-001305.hdr.sgml : 20030207 20030207143319 ACCESSION NUMBER: 0000950152-03-001305 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030207 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: DENTINGER RONALD E CENTRAL INDEX KEY: 0001193420 RELATIONSHIP: OTHER FILING VALUES: FORM TYPE: 5 MAIL ADDRESS: STREET 1: 100 EAST WATER STREET CITY: SANDUSKY STATE: OH ZIP: 44870 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FIRST CITIZENS BANC CORP /OH CENTRAL INDEX KEY: 0000944745 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 341558688 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25980 FILM NUMBER: 03544366 BUSINESS ADDRESS: STREET 1: 100 EAST WATER ST STREET 2: P O BOX 5016 CITY: SANDUSKY STATE: OH ZIP: 44870 BUSINESS PHONE: 4196254121 MAIL ADDRESS: STREET 1: 100 EAST WATER ST STREET 2: P O BOX 5016 CITY: SANDUSKY STATE: OH ZIP: 44870 5 1 l98728ae5.htm FIRST CITIZENS BANC CORP/DENTINGER - FORM 5 First Citizens Banc Corp/Dentinger - Form 5
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM 5

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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

o Check box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
o Form 3 Holdings Reported
o Form 4 Transactions Reported
1. Name and Address of Reporting
Person*		 2. Issuer Name and Ticker or Trading
Symbol		 3. I.R.S. Identification Number of Reporting
Person, if an entity (Voluntary)
  Dentinger, Ronald E
(Last) (First) (Middle)		   First Citizens Banc Corp (FCZA)
 
   
                 
 
16557 E Township Rd #44
4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year)
    12/02
 
  (Street) 6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)		 7. Individual or Joint/Group Reporting
(Check Applicable Line)
  Attica, OH 44870
(City)        (State)        (Zip)		   o  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    x  Other (specify below)  
      Affiliate Director
     
*   If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

                                                 
Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of
Security
(Instr. 3)		 2. Transaction
Date
(Month/Day/Year)		 2A. Deemed Execution
Date, if any
(Month/Day/Year)		 3. Transaction
Code
(Instr. 8)		 4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)		 5. Amount of Securities
Beneficially Owned
at the End of Issuer's
Fiscal Year
(Instr. 3 and 4)		 6. Ownership
Form:
Direct (D) or
Indirect (I)
(Instr. 4)		 7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
                    Amount (A)
or
(D)		 Price            
  Common               4700     D  
  Common       R   16.31   A     294.368     I   Child
  Common       R   24.46   A     441.551     I   Child
                     
                     
                     
                     

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative
Security
(Instr. 3)		 2. Conversion or Exercise
Price of Derivative
Security		 3. Transaction Date
(Month/Day/Year)		 3A. Deemed Execution
Date, if any
(Month/Day/Year)		 4. Transaction Code
(Instr. 8)		 5. Number of Derivative Securities
Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
                            (A) (D)
               
               
               
               
               
               
               
               
               

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)		 7. Title and Amount of
Underlying Securities
(Instr. 3 and 4)		 8. Price of Derivative
Security
(Instr. 5)		 9. Number of Derivative
Securities Beneficially
Owned at End of
Year
(Instr. 4)		 10. Ownership of
Derivative Security:
Direct (D)
or Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
                   
                   
                   
                   
                   
                   
                   
                   
                   

Explanation of Responses:

/s/ Ronald E. Dentinger   2/6/03
**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.

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