1 --------------------------- OMB APPROVAL --------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: September 30, 1998 - -------- Estimated average burden hours per response .... 0.5 --------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 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 4. Issuer Name and Ticker or 6. If Amendment, Date TANKHA ASH Statement Trading Symbol of Original - ---------------------------------------- (Month/Day/Year) Halsey Drug Co., Inc. (HDG) (Month/Day/Year) (Last) (First) (Middle) March 10, 1998 ------------------------------ ------------------------- 36 Greenleigh ---------------------------- 5. Relationship of Reporting 7. Individual or Joint/ - ---------------------------------------- 3. IRS or Social Security Person to Issuer Group Filing (Check (Street) Number of Reporting (Check all applicable) Applicable Line) Person (Voluntary) ___ Director ___ 10% Owner __ Form filed by One Sewell New Jersey 08080 ###-##-#### _X__ Officer _X__ Other Reporting Person - -------------------------------------- ---------------------------- (give title below) (specify below) __ Form filed by More (City) (State) (Zip) Vice President and General Manager than One Reporting --------------------------- Person - ----------------------------------------------------------------------------------------------------------------------------------- TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (8/92) 2
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security Direct ------------------------------------------------- (D) or Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option * * Common Stock 100,000 * D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: * To be determined /s/ A. Tankha April 7, 1998 **Intentional misstatements or omissions of facts constitute Federal 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. Page 2 If space provided is insufficient, See Instruction 6 for procedure. SEC 1473 (8/92)