-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, HcAp4P9ehvMnfuTHppQteOC4VHBlac3rhvB74kJbTGO7Pn5kdTwy3be6akn+QVuV qMXza85xAVoY6jrV1MF9xw== 0001157523-04-011484.txt : 20041215 0001157523-04-011484.hdr.sgml : 20041215 20041215095515 ACCESSION NUMBER: 0001157523-04-011484 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041031 FILED AS OF DATE: 20041215 DATE AS OF CHANGE: 20041215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHAW JEROME CENTRAL INDEX KEY: 0001007671 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09232 FILM NUMBER: 041203394 BUSINESS ADDRESS: STREET 1: C/O VOLT INFORMATION SCIENCES INC STREET 2: 1221 AVE OF THE AMERICAS CITY: NEW YORK STATE: NY ZIP: 10020-1579 BUSINESS PHONE: 2127042435 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: VOLT INFORMATION SCIENCES, INC. CENTRAL INDEX KEY: 0000103872 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HELP SUPPLY SERVICES [7363] IRS NUMBER: 135658129 STATE OF INCORPORATION: NY FISCAL YEAR END: 1031 BUSINESS ADDRESS: STREET 1: 560 LEXINGTON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022-2928 BUSINESS PHONE: 2127042400 MAIL ADDRESS: STREET 1: 560 LEXINGTON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022-2928 FORMER COMPANY: FORMER CONFORMED NAME: VOLT INFORMATION SCIENCES INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: VOLT TECHNICAL CORP DATE OF NAME CHANGE: 19680913 5 1 a4784472_ex.xml X0202 5 2004-10-31 0 0 0 0000103872 VOLT INFORMATION SCIENCES, INC. VOL 0001007671 SHAW JEROME C/O VOLT INFORMATION SCIENCES INC 2401 NORTH GLASSELL STREET ORANGE CA 92865 0 1 1 0 Executive VP and Secretary Common Stock, $.10 par value 2890194 D Common Stock, $.10 par value 6750 I By Spouse Common Stock, $.10 par value 236250 I As Trustee Common Stock, $.10 par value 2979.8756 I By ESOP Common Stock, $.10 par value 21245.1979 I By 401(k) Plan Employee Stock Options (Rights to Buy): 4/22/96 Grant 18.0833 1997-04-23 2006-04-22 Common Stock 45000 45000 D 250,000 shares previously owned directly have been contributed to a separate grantor retained annuity trust on April 16, 2004. Includes 2,886,230 shares owned by a revocable trust for the benefit of the undersigned and his wife. The undersigned may demand that these shares be transferred to him at any time. The filing of this statement shall not be construed as an admission that the undersigned is, for the purpose of Section 16 of the Securities Exchange Act of 1934, or otherwise, the beneficial owner of these securities. Shares are held by the undersigned and his wife as trustees of an Irrevocable Trust for the benefit of a child of the undersigned and his wife. Held in the undersigned's Employee Stock Ownership Plan account in the Company's Savings Plan as of October 31, 2004, the latest date as of which information is available. After giving effect to mandatory distributions taken in cash since the undersigned's last Report on Form 4 or 5. Held in the undersigned's Company Stock Fund under the Company's 401 (k) Plan account in the Company's Savings Plan as of October 31, 2004, the latest date as of which information is available. Exercisable as to 20% per year commencing one year after grant, on a cumulative basis. /s/ Jack Egan, Attorney-in-Fact 2004-12-14 -----END PRIVACY-ENHANCED MESSAGE-----