-----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, TeyUs/c692w6ngneUTGp7YoW/nkiMP5uulKpb5dIiMAOoJ/ZfINVje58mxiMIKoh PgcljENVsAti5IsRsK6Z5Q== 0000896415-97-000167.txt : 19970912 0000896415-97-000167.hdr.sgml : 19970912 ACCESSION NUMBER: 0000896415-97-000167 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970806 FILED AS OF DATE: 19970904 SROS: BSE SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PRECISION OPTICS CORPORATION INC CENTRAL INDEX KEY: 0000867840 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 042795294 STATE OF INCORPORATION: MA FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-10647 FILM NUMBER: 97675214 BUSINESS ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440-3338 BUSINESS PHONE: 5086301800 FORMER COMPANY: FORMER CONFORMED NAME: PRECISION OPTICS CORP INC DATE OF NAME CHANGE: 19600201 COMPANY DATA: COMPANY CONFORMED NAME: KHAJURIVALA KUMAR M CENTRAL INDEX KEY: 0001040742 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: O STREET 2: 252 MASSAPOAG AVE CITY: NORTH EASTON STATE: MA ZIP: 02356 MAIL ADDRESS: STREET 2: 252 MASSAPOAG AVENUE CITY: NORTH EASTON STATE: MA ZIP: 02356 4 1 KUMAR M. KHAJURIVALA FORM 4 OMB APPROVAL OMB NUMBER: 3235-0287 - --- CHECK BOX IF NO LONGER EXPIRES: SEPTEMBER 30, 1998 - --- SUBJECT TO SECTION 16. FORM 4 ESTIMATED AVERAGE BURDEN OR FORM 5 OBLIGATIONS MAY HOURS PER RESPONSE....0.5 CONTINUE. SEE INSTRUCTION 1(B). (Print or type responses) 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(f) of the Investment Company Act of 1940
1. Name and 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer Address of Precision Optics Corporation (POCI) (Check all applicable) Reporting Director 10% Owner Person* X Officer (give title Other (specify below) below) --------------------------------------------------- V.P. of Operations --------------------------------------------------- Khajurivala Kumar M. - -------------------------- --------------------- -------------------------- (Last) (First)(Middle) 3. IRS or Social 4. Statement for Month/Year 13 Lincoln Street Security Number of 8/97 - ------------------------- Reporting Person (Street) (Voluntary) Ashburnham MA 01430 ###-##-#### - ------------------------- --------------------- ------------------------- (City) (State) (Zip) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Original (Month/Year) (Check Applicable Line) N/A X Form Filed by One Reporting Person Form Filed by More than One Reporting Person
TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A)or 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Month/ (Instr. 8) Owned at End Direct(D) Beneficial Day/Year) of Month or Indirect(I) Ownership (Instr.3 and 4) (Instr.4) (Instr.4) Code V Amount (A)or(D) Price Common Stock 8/6/97 S 6,000 D $3.000 70,000 D
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, (Over) see Instruction 4(b)(v). SEC 1474 (7-96) FORM 4 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1.Title of 2.Conver- 3.Trans- 4.Trans- 5. Number of 6. Date Exer- 7.Title and 8. Price 9. Number 10. Owner- 11.Na- Derivative sion or action action Derivative cisable and Ex- Amount of of of ship ture Security Exercise Date Code Securities piration Date Underlying Deriv- Deriv- Form of of In- (Instr.3) Price of (Month/ (Instr.8) Acquired(A) (Month/Day/ Securities ative ative De- direct Deriv- Day/ or Disposed Year) (Instr. Secur- Secur- rivative Bene- ative Year) of (D) 3 and 4) ity ities Secu- ficial Security (Instr.3,4 Instr. Bene- rity: Own- and 5) 5) ficially Direct ership Owned at (D) or (Instr.4) End of Indi- Month rect (I) Expi- Amount (Instr.4) (Instr.4) Date ra- Title or Code V (A) (D) Exer- tion Number cisable Date of Shares
- -------------------------------- ----------- ------------------------ ---------- Explanation of Responses: **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 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 required to respond unless the form displays a currently valid OMB Number. /s/Kumar M. Khajurivala September 3, 1997 ------------------------ ------------- **Signature of Reporting Date Person Page 2 SEC 1474 (7-96) -----END PRIVACY-ENHANCED MESSAGE-----