First Citizens Banc Corp/James E. McGookey Form 3

-----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, MYBfolagIF8FZ+IlBYaqb+d4X44s1f7VXR9YwvmNh7ZOZXwHkZZHRK6ybtmyAS0b odUZ9ilYDHhQb+THJBE0AA== 0000950152-03-001309.txt : 20030207 0000950152-03-001309.hdr.sgml : 20030207 20030207143835 ACCESSION NUMBER: 0000950152-03-001309 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021202 FILED AS OF DATE: 20030207 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: MCGOOKEY JAMES E CENTRAL INDEX KEY: 0001213312 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 3 MAIL ADDRESS: STREET 1: 100 EAST WALTER 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: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25980 FILM NUMBER: 03544388 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 3 1 l98729ae3.htm FIRST CITIZENS BANC CORP/JAMES E. MCGOOKEY FORM 3 First Citizens Banc Corp/James E. McGookey Form 3

OMB APPROVAL

OMB Number: 3235-0104

Expires: January 31, 2005

Estimated average burden
hours per response...0.5

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM 3

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

1. Name and Address of Reporting
Person* 2. Date of Event Requiring Statement
(Month/Day/Year) 3. I.R.S. Identification Number of Reporting
Person, if an entity (voluntary)

McGookey, James E. 12/02/02

(Last)             (First)           (Middle)

3221 Country Club Lane 4. Issuer Name and Ticker or Trading Symbol 5. Relationship of Reporting Person(s) to Issuer

First Citizens Banc Corp (FCZA) (Check all applicable)

(Street)
[   ] Director [X] Officer (give title below)

6. If Amendment, Date of Original
(Month/Day/Year) [   ] 10% Owner [   ] Other (specify below)

Huron, Ohio 44839 SVP Legal Counsel

(City)                (State)            (Zip)

7. Individual or Joint/Group Filing
(Check Applicable Line)

[X] Form filed by One Reporting Person
[   ] Form filed by More than One Reporting
Person

FORM 3 (CONTINUED)

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 160 D

Common 160 I spouse

* If the form is filed by more than one reporting person, see Instruction 5(b)(v).

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 Deri-
vative Security
(Instr. 4) 4. Conversion
or Exercise
Price of
Derivative
Security 5. Ownership Form
of Derivative Se-
curity: Direct (D)
or Indirect (I)
(Instr. 5) 6. Nature of
Indirect
Beneficial
Ownership
(Instr. 5)

Date
Exer-
cisable Expi-
ration
Date
Title Amount
or
Number
of Shares

Explanation of Responses:

Late Filing-Time delay receiving EDGAR codes and ownership information.

/s/ James E. McGookey February 6, 2003

**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 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.

Page 2 -----END PRIVACY-ENHANCED MESSAGE-----


1.	Name and Address of Reporting Person*	2.	Date of Event Requiring Statement (Month/Day/Year)	3.	I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
	McGookey, James E.		12/02/02
	(Last) (First) (Middle)
	3221 Country Club Lane	4.	Issuer Name and Ticker or Trading Symbol	5.	Relationship of Reporting Person(s) to Issuer
			First Citizens Banc Corp (FCZA)		(Check all applicable)
	(Street)				[ ] Director	[X] Officer (give title below)
		6.	If Amendment, Date of Original (Month/Day/Year)		[ ] 10% Owner	[ ] Other (specify below)
	Huron, Ohio 44839				SVP Legal Counsel
	(City) (State) (Zip)
		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 (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		160		D

	Common		160		I		spouse

/s/ James E. McGookey		February 6, 2003
**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 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.