FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION |
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Washington, D.C. 20549 |
OMB APPROVAL |
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Check this box if no longer subject to |
OMB Number: 3235-0362 |
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Section 16. Form 4 or Form 5 obligations |
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |
Expires: January 31, 2005 |
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may continue. See instruction 1(b). |
Estimated average burden |
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Form 3 Holdings Reported |
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility |
hours per response. .1.0 |
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Form 4 Transactions Reported |
Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person* |
2. Issuer Name and Ticker or Trading Symbol |
6. Relationship of Reporting Person(s) to Issuer |
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(Check all applicable) |
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Duckless |
Elwood |
G. |
Community Bancorp. |
CMTV |
__X___Director |
_____ 10% Owner |
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(Last) |
(First) |
(Middle) |
3. I.R.S. Identification |
4. Statement for |
______Officer (give |
_____ Other (specify below) |
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Number of Reporting |
Month/Day/Year |
title below) |
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4924 VT Route 14 |
Person, if an entity |
12/ |
31 |
/2002 |
_________________________ |
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(Street) |
(Voluntary) |
5. If Amendment, Date of |
7. Individual or Joint/Group Filing (Check Applicable Line) |
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Newport |
VT |
05855 |
Original (Month/Day/Year) |
_X_Form filed by One Reporting Person |
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(City) |
(State) |
(Zip) |
009-28-0900 |
___Form filed by More than One Reporting Person |
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Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of Security |
2. Trans- |
2A. |
3. Transaction |
4. Securities Acquired (A) |
5. Amount of |
6. Ownership |
7. Nature of |
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(Instr. 3) |
action |
Deemed |
Code |
or Disposed of (D) |
Securities |
Form: |
Indirect |
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Date |
Execution |
(Instr. 8) |
(Instr. 3, 4 and 5) |
Beneficially |
Direct (D) |
Beneficial |
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Date, if |
Owned |
or Indirect |
Ownership |
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any |
at End of |
(I) |
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(Month/ |
(Month/ |
(A) |
Issuer's |
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Day/ |
Day/ |
or |
Fiscal Year |
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Year) |
Year) |
Code |
V |
Amount |
(D) |
Price |
(Instr. 3 and 4) |
(Instr. 4) |
(Instr. 4) |
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Community Bancorp. Common Stock |
103,950 |
I |
Held by Trust |
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Community Bancorp. Common Stock |
21,313 |
I |
Held by Trust |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
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*If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
SEC 2270 (9-02) |
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**Intentional misstatements or ommissions of facts constitute Federal Criminal |
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Violations. See 18 U.S.C. 1001 and U.S.C. 78ff(a). |
/s/ Elwood G. Duckless |
1/14/2003 |
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Persons who respond to the collection of information contained in this form are not required |
**Signature of Reporting Person |
Date |
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to respond unless the form displays a currently valid OMB control number. |
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NOTE: Table II Not Applicable at this time |