FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of |
Estimated average burden hours per response...0.5 |
|||
(X ) |
Check this box if no longer |
||||
(Print or Type Responses) |
1. Name and Address of Reporting Person* ________________________________ (Last) (First) (Middle) 1701 NW Fawn Place ________________________________ (Street) Blue Springs, MO 64015-6449 ________________________________ (City (State) (Zip) |
2. Issuer Name and Ticker or Trading Symbol |
4. Statement for
|
6. Relationship of Reporting Person(s) to Issuer Officer (give title below) __X_ Other (specify below) |
||||||||||
3. I.R.S. Identification Number of
|
5 If Amendment, |
7. Individual or Joint/Group Filing (Check Applicable Line) |
|||||||||||
Table I ¾ Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
|||||||||||||
1. Title of Security |
2. Transaction |
2A. Deemed |
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) |
||||||
Code |
V |
Amount |
(A) or |
Price |
|||||||||
Common Stock |
1,253 |
D |
|||||||||||
4,765 |
D |
IRA |
|||||||||||
FORM 4 (continued) |
Table II `
Derivative Securities Acquired, Disposed of, or Beneficially Owned |
||||||||||||||||||||
1. Title of |
2. Conversion |
3. Transaction |
3A. Deemed |
4. Transaction |
5. Number of |
6. Date Exercisable |
7. Title and Amount of |
8. Price of |
9. Number of |
10. Ownership |
11. Nature of |
||||||||||
Code |
V |
(A) |
(D) |
Date |
Expiration |
Title |
Amount or |
||||||||||||||
Explanation of Responses:
Executed on behalf of Ronald G. Wasson by Jeanie Sell Latz (see Attached Exhibit A - Power of Attorney) |
|||||||||||||||||||||
|
|||||||||||||||||||||
/s/Jeanie Sell Latz |
November 7, 2002 |
||||||||||||||||||||
**Signature of Reporting Person |
Date |
||||||||||||||||||||
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
|||||||||||||||||||||
* |
If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
||||||||||||||||||||
** |
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. |
Exhibit A
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That the undersigned, former Chairman of the Board and Director of KLT Inc., a Missouri corporation, does hereby constitute and appoint Bernard J. Beaudoin, Jeanie S. Latz or Mark G. English, his true and lawful attorney and agent, with full power and authority to execute in the name and on behalf of the undersigned director a Report on Form 4 or Form 5 and all amendments thereto; hereby granting unto such attorney and agent full power of substitution and revocation in the premises; and hereby ratifying and confirming all that such attorney and agent may do or cause to be done by virtue of these presents.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7th day of November, 2002.
/s/Ronald G. Wasson |
Ronald G. Wasson |
STATE OF MISSOURI |
) |
) ss |
|
COUNTY OF JACKSON |
) |
On this 7th day of November, 2002, before me the undersigned, a Notary Public, personally appeared Ronald G. Wasson, to be known to be the person described in and who executed the foregoing instrument, and who, being by me first duly sworn, acknowledged that he executed the same as his free act and deed.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal the day and year last above written.
/s/Linda S. King |
Notary Public |
Jackson County, |
My Commission Expires: |