5 1 edgarized5hinds92002.txt ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB APPROVAL OMB Number: 3235-0362 Expires: January 31, 2005 Estimated average burden hours per response 1.0 _________________________ Form 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D. C. 20549 Annual Statement of Changes in Beneficial Ownership 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(h) of the Investment Company Act of 1940 [X] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1 (b). [ ] Form 3 Holdings Report [X] Form 4 Transactions Report (Print or type responses) __________________________________________________ 1. Name and Address of Reporting Person* Hinds, Jr. Edward D. __________________________________________________ (Last) (First) (Middle) 3416 West Magill Avenue __________________________________________________ (Street) Fresno CA 93711 __________________________________________________ (City) (State) (Zip) __________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Pismo Coast Village, Inc. __________________________________________________ 3. IRS Identification Number of Reporting Person, If an Entity (Voluntary) ###-##-#### __________________________________________________ 4. Statement for Month/Year 09/2002 __________________________________________________ 5. If Amendment, Date of Original (Month/Year) __________________________________________________ 6. Relationship of Reporting Persons) to Issuer (Check all applicable) X Director ___ 10% Owner X Officer (give title) Vice President - Secretary ___ Other (specify) ________________________ __________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by one reporting Person ___ Form filed by More than One Reporting Person ================================================================================================= Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned =================================================================================================
1. |2. |2A. |3. |4. |5. |6. |7. | Title |Trans- |Deemed |Trans-|Securities |Amount of |Ownership |Nature | of |action |Execution|action|Acquired (A) or |Securities |Form: |Of | Security|Date |Date |Code |Disposed (D)of |Beneficially |Direct (D) |Indirect | |(M/D/Y) |(M/D/Y) | |Amount |(A)|Price |Owned at the |or Indirect|Beneficial| | | | | |or | |end ofIssuer's|(I) |Ownership | | | | | |(D | |Fiscal Year | | | ________|________|_________|______|_______|___|______|______________|___________|__________| Common |9/23/02 | | S |1 share| D |$13500|0 shares | N/A | N/A |
================================================================================================ Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., Puts, calls, warrants, options, convertible securities) =================================================================================================
1. |2. |3. |3A. |4. |5. |6. |7. |8. |9. |10. |11. | Ti- |Con- |Trans-|Deemed |Trans-|Number |Date |Title and |Price|Number |Owner-|Nature| tle |ver- |action|Execu- |action|of Deri-|Exercisable|Amount of |of |of |ship |of | of |sion |Date |tion |Code |vative |and |Underlying |Deri-|Deri- |of |In- | De- |or |(M/D/Y|Date | |Securi- |Expiration |Securities |va- |vative |De- |direct| ri |Exer- | |(M/D/Y)| |ties |Date | |tive |Secur- |riva- |Bene- | va- |cise | | | |Acquired|(M/D/Y) | |Sec- |ties |tive |ficial| tive|Price | | | |(A) or | | |urity|Benefi-|Secur-|Owner-| Sec-|of | | | |Disposed| | | |cially |ities |ship | ur- |Deri- | | | |(D) of | | | |Owned |Direct| | ity |vative| | | | | | | |at end |(D) or| | |Secur-| | | |________|___________|____________| |of Year|Indi- | | |ity | | | |(A)|(D) |Date |Ex- |Title|Amount| | |ect | | | | | | | | |Exer-|pira-| |or | | |(I) | | | | | | | | |cisa-|tion | |Number| | | | | | | | | | | |ble |Date | |of | | | | | | | | | | | | | | |Shares| | | | | ____|______|______|_______|______|___|____|_____|_____|_____|______|_____|_______|______|______| ____|______|______|_______|____|_|___|____|_____|_____|_____|______|_____|_______|______|______|
Explanation of Responses: /S/ EDWARD D. HINDS, JR. September 23, 2002 **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U. S. C. 1001 and 15 U. S. C. 78 ff (a) Note: File three copies of this Form, one of which must be manually signed. If space is insufficient see Instruction 6 for procedure.