SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
01/01/2004
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3. Issuer Name and Ticker or Trading Symbol
LAWSON PRODUCTS INC/NEW/DE/
[ LAWS ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| 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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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| No securities beneficially owned |
0 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
|
Nancy Gonzales, as Attorney-in-fact |
01/05/2004 |
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** 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
5
(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. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
POWER OF ATTORNEY
-----------------
The undersigned constitutes and appoints Joseph Pawlick, Nancy
Gonzales, and Neil Jenkins as the undersigned's true and lawful attorney-in-fact
and agent, with full power of substitution and resubstitution, for the
undersigned and in the undersigned's name, place and stead, to sign any and all
Securities and Exchange Commission statements of beneficial ownership of
securities of Lawson Products, Inc. (the "Company") on Forms 3, 4 and 5 as
required under Section 16(a) of the Securities Exchange Act of 1934, as amended,
and to file the same with all exhibits thereto, and other documents in
connection therewith, with the Securities and Exchange Commission, the Company
and NASDAQ, granting unto said attorney-in-fact and agent full power and
authority to do and perform each act and thing requisite and necessary to be
done under said Section 16(a), as fully and to all intents and purposes as the
undersigned might or could do in person, hereby ratifying and confirming all
that said attorney-in-fact and agent may lawfully do or cause to be done by
virtue hereof.
A copy of this power of attorney shall be filed with the Securities and
Exchange Commission. The authorization set forth above shall continue in full
force and effect until the undersigned revokes such authorization by written
instructions to the attorney-in-fact.
The authority granted hereby shall in no event be deemed to impose or
create any duty on behalf of the attorney-in-fact with respect to the
undersigned's obligations to file Forms 3, 4 and 5 with the Securities and
Exchange Commission.
Dated: December 23, 2003
/s/ Wilma Smelcer
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Wilma Smelcer
