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)
04/21/2004
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3. Issuer Name and Ticker or Trading Symbol
DANA CORP
[ DCN ]
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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 |
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| 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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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: |
| Remarks: |
|
| No securities are beneficially owned. |
|
Samir Gibara |
04/21/2004 |
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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
I hereby constitute and appoint Michael L. DeBacker, M. Jean
Hardman, Mark A. Smith, Jr., Pamela W. Fletcher, Lisa A.
Amend and Laura L. Aossey, or any one of them, as my true
and lawful attorneys-in-fact to (i) complete Securities and
Exchange Commission Forms 3, 4, and 5, based on the
information that I may furnish to them from time to time;
(ii) execute all such completed Forms for and on my behalf;
and (iii) file all such completed Forms with the Securities
and Exchange Commission and the New York Stock Exchange, all
in accordance with Section 16(a) of the Securities Exchange
Act of 1934 and the rules thereunder.
I acknowledge that the foregoing persons, in serving as
my attorneys-in-fact hereunder, do not assume any of the
obligations or liabilities that are imposed on me by
Section 16 of the Securities Exchange Act of 1934 and the
rules thereunder.
This Power of Attorney shall remain in full force and
effect until such time as I deliver a written revocation
hereof to the foregoing attorneys-in-fact, or any one of
them.
IN WITNESS WHEREOF, I have executed this Power of
Attorney this 20th day of April, 2004.
/s/ Samir Gibara
Signed, acknowledged, and delivered
in the presence of: Witness:
/s/ Theresa S. Whetro /s/ Susan J. Stewart
County of Lucas )
) ss:
State of Ohio )
Sworn and subscribed before me this 20th day of
April, 2004.
/s/ Robert E. Pollock, Attorney at Law
Notary Public, State of Ohio
My Commission has no expiration date.
Section 147.03 R.C.
[Seal]
