Sec Form 4 Filing - Elliott Jennifer Aplin @ HICKOK INC - 2012-12-30

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
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1. Name and Address of Reporting Person
Elliott Jennifer Aplin
2. Issuer Name and Ticker or Trading Symbol
HICKOK INC [ HICKA]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
1178 BELLINGHAM DR.
3. Date of Earliest Transaction (MM/DD/YY)
12/30/2012
(Street)
OCEANSIDE, CA92057
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock, no par value. 12/30/2012 12/30/2012 M 112,752 A $ 1.85 127,411 I By Trust
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Convertible Promissory Note $ 1.85 12/30/2012 12/30/2012 M 112,752 12/30/2011 12/30/2012 Class A Common Stock 112,752 ( 1 ) 0 I By Trust
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Elliott Jennifer Aplin
1178 BELLINGHAM DR.
OCEANSIDE, CA92057
X X
Signatures
/s/Jennifer A. Elliott 01/02/2013
Signature of Reporting Person Date
Explanation of Responses:
( 1 )1. On December 30, 2011, Hickok Incorporated (the "Company") entered into a Convertible Loan Agreement (the "Convertible Loan Agreement") with the Aplin Family Trust (the "Aplin Trust") among others. Under the Convertible Loan Agreement, the Company issued a convertible note to the Aplin Trust in the principal amount of $208,591.20 ( the "Note"). The Convertible Loan Agreement provided that the Note may be converted by the Aplin Trust at any time, in whole or in part, into Class A Common Shares of the Company ("Conversion Shares") at a conversion price of $1.85 per share. The Aplin Note may not be converted into more than 112,752 Conversion Shares.

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