-----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, EvwlCiZG9lMoC98ELNNQjYm4o3c1iJYcoFQ08JeCEBsOvEiv2NUx7ErUp/O8q5lt JVJyta/avXIaD4Tf4iMDEQ== 0000896415-97-000091.txt : 19970808 0000896415-97-000091.hdr.sgml : 19970808 ACCESSION NUMBER: 0000896415-97-000091 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970709 FILED AS OF DATE: 19970807 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: 1934 Act SEC FILE NUMBER: 001-10647 FILM NUMBER: 97653128 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: DREIMILLER JACK P CENTRAL INDEX KEY: 0001040741 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 7/97 - ------------------------- 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/ (Instruc.8) Owned at Direct Bene- Day/ -------- ----- --------- --------- ------- End of (D) or ficial Year) Code V Amount (A) or Price Month Indirect Owner- (D) (Instr. 3 and 4) (I) ship (Instr. 4) (Instr. 4) - -------------- --------------- ------- ----- --------- --------- ------- ------------------- ----------- ------- Common Stock 7/9/97 M 22,500 A $1.375 Common Stock 7/11/97 S 22,500 D $3.375 Common Stock 7/30/97 S 5,141 D $3.000 76,000 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- Derivative sion or action action Derivative cisable and Ex- Amount of of of ship Security Exercise Date Code Securities piration Date Underlying Deriv- Deriv- Form of (Instr.3) Price of (Month/ (Instr.8) Acquired(A) (Month/Day/ Securities ative ative De- Deriv- Day/ or Disposed Year) (Instr. Secur- Secur- rivative ative Year) of (D) 3 and 4) ity ities Secu- Security (Instr.3,4 Instr. Bene- rity: and 5) 5) ficially Direct Owned at (D) or 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 Stock Options $1.375 7/9/97 M 22,500 See below 12/15/04 Com- 22,500 97,500 D mon Stock 11. Na- ture of In- direct Bene- ficial Own- ership (Instr. 4)
Explanation of Responses: Options were exercisable on the following dates: 12/15/94: 7,500 12/15/95: 7,500 12/15/96: 7,500 **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 August 7, 1997 ------------------------ ------------- **Signature of Reporting Date Person Page 2 SEC 1474 (7-96) -----END PRIVACY-ENHANCED MESSAGE-----