| 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 or Section 30(h) of the Investment Company Act of 1940 |
| |||||||||||||||
| 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 Reported. | |||||||||||||||||
| Form 4 Transactions Reported. | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol BALTIA AIR LINES INC [ BLTA ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| ||||||||||||||||||||||||
| 3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year) 12/31/2014 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
| |||||||||||||||||||||||||
| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
| Amount | (A) or (D) | Price | |||||||||||||
| Common Shares | 12/16/2014(3) | J5 | 8,500(1) | D | $0.015(2) | 851,654,266(4) | D | ||||||||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
| Explanation of Responses: |
| 1. This represents shares that were apparently sold or otherwise disposed of by the broker for payment of brokerage fees for holding the reporting person's shares since 5/19/2011. It is the difference between the original transfer of 54,000,000 shares to the broker on that date and the re-listing of those shares, in the reduced amount of 53,991,500, in the name of the reporting person by the transfer agent on 12/16/2014. At present it is unknown when those shares were sold, or transferred to another account as appears to be the case. |
| 2. Inasmuch as it is unknown when said shares were transferred by the holding Broker, apparently for fees, sometime between May 2011 and 11/22/2013, the best estimate of the value of those shares is .015 which represents a price between .01 and .02 which is the general range of market price fluctuations during that period. |
| 3. This is the date that shares, originally issued to a broker on May 19, 2011 in the amount of 54,000,000, were returned to the Company's Transfer Agent for listing in the reporting person's name, reduced by 8,500 shares. |
| 4. This number derives from a recent audit of share ownership of the company, and includes 54,000,000 originally reported as "cancelled due to administrative error" on May 19, 2011 when in fact they were transferred into CEDE and CO FAST for listing in a brokerage account for the benefit of the reporting person. |
| Remarks: |
| The Form 5 filed on 10/23/2012 (for Fiscal Year 2011) erroneously recorded a transfer to a broker as a disposition of 54,000,000 shares, reducing overall ownership by the reporting person by that number of shares. This error was discovered on a recent audit of the share ownership provoked by the re-listing of the shares with the transfer agent from the broker in the amount of 53,991,500 on December 16, 2014. |
| Igor Dmitrowsky by Albert Z Lewis POA | 04/30/2015 | |
| ** 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. | ||
| 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. | ||
