FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of |
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£ |
Check this box if no longer |
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£ |
Form 3 Holdings Reported |
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£ |
Form 4 Transactions Reported |
1. Name and Address of Reporting Person* |
2. Issuer Name and Tickler or Trading Symbol Synalloy Corporation SYNC |
6. Relationship of Reporting Person(s) to Issuer |
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X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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(Last) (First) (Middle) |
3. I.R.S. Identification Number of |
4. Statement for Month/Year |
7. Individual or Joint/Group Filing (Check Applicable Line) |
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5. If Amendment, Date of |
X |
Form filed by One Reporting Person |
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(Street) |
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Form filed by More than One Reporting Person |
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(City) (State) (Zip) |
Table I ¾ Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of Security |
2. Transaction Date |
3. Transaction |
4. Securities Acquired (A) |
5. Amount of Securities |
6. OwnershipForm: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature ofIndirect Beneficial Ownership (Instr. 4) |
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Amount |
(A) or |
Price |
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Common Stock |
186,000 |
D |
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Common Stock |
45,000 |
I |
IRA |
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Common Stock |
860 |
I |
By Son (Custodial) |
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Common Stock |
400 |
I |
By Daughter (Custodial) |
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* If the form is filed by more than one reporting person, see instruction 4(b)(v).
FORM 5 (continued) |
Table II `
Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of |
2. Conversion |
3. Transaction (Month/Day/Year) |
4. Transaction |
5. Number of |
6. Date Exercisable |
7. Title and Amount |
8. Price of |
9. Number of |
10. Ownership |
11. Nature of |
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(A) |
(D) |
Date |
Expiration |
Title |
Amount or |
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1994 Non-Employee Directors Stock Option Plan |
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1,500 |
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Common Stock |
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3,000 |
D |
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Explanation of Responses: |
Cheryl C. Carter |
January 6, 2003 |
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**Signature of Reporting Person /s/ Cheryl C. Carter, Power of Attorney |
Date |
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** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. |
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See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
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Note: |
File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |