FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION |
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Washington, D.C. 20549 |
OMB Number 3235-0104 |
(Print or Type Responses) |
OWNERSHIP OF SECURITIES |
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1. Name and Address of Reporting Person* Smith, Dan L. (Last) (First) (Middle) |
4. Issuer Name and
Ticker or Trading Symbol Chemical Financial Corporation (CHFC) |
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5. Relationship of
Reporting Person(s) to Issuer (Check all applicable) X Director   10% Owner X Officer (give title Other (specify below) below)   Chairman of the Board of Shoreline Bank |
Benton Harbor, MI 49022 (City) (State) (Zip) |
6. If Amendment, Date of Original (Month/Day/Year) |
2. Date of Event Requiring
Statement (Month/Day/Year) January 9, 2001 |
7. Individual or Joint/Group
Filing (Check Applicable Line) X Form Filed by One Reporting Person Form Filed by More than One Reporting Person |
3. I.R.S. Identification
Number of Reporting Person, if an entity (voluntary) |
Table I -- Non-Derivative Securities Beneficially Owned |
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1. Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned (Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership (Instr. 4) |
Common Stock |
49,371(1)
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D
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Common Stock |
12,264(1)
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I
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By Spouse Trust
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Common Stock |
5,882(1)
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I
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401(k) Plan
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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).
Potential persons who are to respond
to the collection of Information contained in this form are not required
to respond unless the form displays a currently valid OMB control number.
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(Over)
SEC 1473 (3-99) |
Form 3 (continued) | Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
1. Title of Derivative
Security (Instr. 4) |
2. Date Exer- cisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of
Securities Underlying Derivative Security (Instr. 4) |
4. Conver- sion or Exercise Price of Deri- vative Security |
5. Owner- ship Form of Deriv- ative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature
of Indirect Beneficial Ownership (Instr. 5) |
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Date Exer- cisable |
Expira- tion Date |
Title |
Amount
or Number of Shares |
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By /s/ Dan L. Smith |
January 19, 2001 |
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**Intentional misstatements or omissions of facts constitute Federal Criminal | **Signature of Reporting Person | Date | ||
Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Dan L. Smith By Jeffrey A. Ott Attorney-In-Fact |
POWER OF ATTORNEY
The undersigned, a director and/or officer of Chemical Financial Corporation, a Michigan corporation (the "Company"), does hereby nominate, constitute and appoint Aloysius J. Oliver, David B. Ramaker, Lori A. Gwizdala and Jeffrey A. Ott, or any one or more of them, his or her true and lawful attorneys and agents to do any and all acts and things and to execute and file any and all instruments that such attorneys and agents, or any of them, may deem necessary or advisable to enable the undersigned (in his or her individual capacity or in a fiduciary or other capacity) to comply with the Securities Exchange Act of 1934, as amended (the "Act"), and any requirements of the Securities and Exchange commission in respect thereof, in connection with the preparation, execution and filing of any report or statement of beneficial ownership or changes in beneficial ownership of securities of the Company that the undersigned (in his or her individual capacity or in a fiduciary or other capacity) may be required to file pursuant to Section 16(a) of the Act including, without limitation, full power and authority to sign the undersigned's name, in his or her individual capacity or in a fiduciary or other capacity, to any report or statement on Form 3, 4 or 5, or to any amendments or any successor forms thereto, or any form or forms adopted by the Securities and Exchange Commission in lieu thereof or in addition thereto, hereby ratifying and confirming all that such attorneys and agents, or any of them, shall do or cause to be done by virtue hereof.
The undersigned agrees that the attorneys-in-fact named herein may rely entirely on information furnished orally or in writing by the undersigned to such attorneys-in-fact.
This authorization shall supersede all prior authorizations to act for the undersigned with respect to securities of the Company in these matters, which prior authorizations are hereby revoked, and shall survive the termination of the undersigned's status as a director and/or officer of the Company and remain in effect thereafter for so long as the undersigned (in his or her individual capacity or in a fiduciary or other capacity) has any obligation under Section 16 of the Act with respect to securities of the Company.
Date: January 18th, 2001 |
/s/ Dan L. Smith Dan L. Smith |