Form 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
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
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OMB APPROVAL |
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OMB Number: 3235-0362 |
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Expires: January 31, 2005 |
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Check 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 |
Estimated average burden
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1. Name and Address of Reporting Person*
Lewis Robert A. |
2. Issuer Name
and
Ticker or Trading Symbol
Dollar General Corporation (DG) |
6. Relationship of Reporting Person(s) to Issuer
title below) below)
Vice President and Controller |
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(Last) (First) (Middle)
100 Mission Ridge |
3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) |
4. Statement for Month/Year
January 31, 2003 |
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(Street)
Goodlettsville TN 37072 |
5. If Amendment, Date of Original (Month/Year) |
7. Individual or Joint/Group Filing
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(City) (State) (Zip) |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security
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2. Trans-
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2A.
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3. Transaction
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4. Securities Acquired (A) or Disposed of (D)
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5. Amount of Securities Beneficially Owned at the end of Issuer's Fiscal Year (Instr. 3 and 4) |
6. Owner-
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7. Nature of Indirect Beneficial Ownership
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Amount |
(A)
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Price |
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FORM 5 (continued) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Derivative Security
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2. Conversion or
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3. Transaction
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3A. Deemed
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4. Transaction Code
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5. Number of Derivative
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6. Date Exercisable
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7. Title and Amount of Underlying Securities
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8. Price of
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9. Number of Derivative Securities Beneficially Owned at End of Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code |
V |
(A) |
(D) |
Date
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Expiration
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Title |
Amount or
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Employee Stock Option (Right to Buy) |
$16.14 |
08/12/02 |
A |
25,200 |
(1) |
08/12/12 |
Common Stock |
25,200 |
25,200 |
D |
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Explanation of Responses:
The option vests in four equal annual installments beginning on August 12, 2003. |
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
/s/ Robert A. Lewis
**Signature of Reporting Person |
3/14/2003
Date |
Note: |
File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. |
Potential persons who are to respond to the collection of information contained in this form are not
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Page 2 |
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and appoints Susan S. Lanigan the undersigneds true and lawful attorney-in-fact to:
(1)
execute for and on behalf of the undersigned, in the undersigneds capacity as an officer and/or director of Dollar General Corporation (the Company), Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder;
(2)
do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4 or 5 and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and
(3)
take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-facts discretion.
The undersigned hereby grants to such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-facts substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, is not assuming, nor is the Company assuming, any of the undersigneds responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigneds holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 7 day of March, 2003.
/s/ Robert A. Lewis ____________________
Robert A. Lewis