-----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, BMqUnRQS0LfpHF1axn5BAEDHxKmvXw9vciWEQmEXKSP2riGINX4TaOLkSnrARlv7 SDpxW1zXWO31OdrH1+EeyQ== 0000950135-98-006119.txt : 19981204 0000950135-98-006119.hdr.sgml : 19981204 ACCESSION NUMBER: 0000950135-98-006119 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981130 FILED AS OF DATE: 19981203 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: 98763174 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: SHANNON ROBERT R CENTRAL INDEX KEY: 0001059135 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 7040 E TAOS PLACE CITY: TUCSON STATE: AZ ZIP: 85715 4 1 PRECISION OPTICS CORP. ON BEHALF OF ROBERT SHANNON 1 - ------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL - ------ ----------------------------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287 [ ] CHECK BOX IF NO Expires: September 30, 1998 LONGER SUBJECT TO Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Estimated average burden SECTION 16. FORM 4 Section 17(a) of the Public Utility Holding Company Act of 1935 hours per response........0.5 OR FORM 5 OBLIGATIONS or Section 30(f) of the Investment Company Act of 1940 ----------------------------- MAY CONTINUE. SEE INSTRUCTION 1(b). (PRINT OR TYPE RESPONSES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Precision Optics Corporation, Inc. (POCI) Issuer (Check all applicable) Shannon Robert R. [X] Director [ ] 10% Owner - ----------------------------------------- ---------------------------------------------- Officer (give [ ] Other (Specify (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for title below) Number of Reporting Month/Year below) 7040 E. Taos Place Person (Voluntary) 11/98 - ----------------------------------------- ------------------------------------------------------------ (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of (Check Applicable Line) Original [X] Form Filed by One Reporting Person (Month/Year) [ ] Form Filed by More than One Tucson AZ 85715 Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature of (Instr. 3) action tion or Disposed of (D) curities Benefi- ship Form; Indirect Date Code (Instr. 3, 4 and 5) cially Owned at Direct Benefi- (Month/ (Instr. 8) End of Month (D) or cial Day/ --------------------------------------- (Instr. 3 and 4) Indirect Ownership Year) Code V Amount (A) or Price (I) (Instr. (D) (Instr. 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) * If the form is filed by more than one reporting person, see Instruction 4(b)(v). SEC 1474 (7-96)
2 FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Expiration Securities Deriv- Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative Deriv- Day/ 8) or Disposed (Month/Day/ Secur- ative Year) of (D) Year) ity Security (Instr. 3, (Instr. 5) 4, and 5) ---------------------------------------- Date Expira- Amount or ---------------------------- Exer- tion Title Number of Code V (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (to buy) $1.312 11/10/98 A 5,000 11/10/98 11/10/08 Common Stock 5,000 $0.00 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative Form of Indirect Securities Derivative Beneficial Beneficially Security: Ownership Owned at End Direct (D) (Instr. 4) of Month or Indirect (I) (Instr. 4) (Instr. 4) - --------------------------------------------------------------------- 66,500 D - --------------------------------------------------------------------- - --------------------------------------------------------------------- - --------------------------------------------------------------------- - --------------------------------------------------------------------- - --------------------------------------------------------------------- - --------------------------------------------------------------------- Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Robert R. Shannon 12/2/98 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -------------------------------- ------- ** Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. Robert R. Shannon If space provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this Page 2 form are not required to respond unless the form displays a currently valid OMB Number. (SEC) SEC 1474 (7-96) 3348751.01
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