0001019687-12-003523.txt : 20121001 0001019687-12-003523.hdr.sgml : 20121001 20121001165328 ACCESSION NUMBER: 0001019687-12-003523 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120928 FILED AS OF DATE: 20121001 DATE AS OF CHANGE: 20121001 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PRECISION OPTICS Corp INC CENTRAL INDEX KEY: 0000867840 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 042795294 STATE OF INCORPORATION: MA FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440 BUSINESS PHONE: 978-630-1800 MAIL ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440 FORMER COMPANY: FORMER CONFORMED NAME: PRECISION OPTICS CORPORATION INC DATE OF NAME CHANGE: 19930328 FORMER COMPANY: FORMER CONFORMED NAME: PRECISION OPTICS CORP INC DATE OF NAME CHANGE: 19600201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FORKEY RICHARD E CENTRAL INDEX KEY: 0000898388 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-10647 FILM NUMBER: 121120493 MAIL ADDRESS: STREET 1: C/O PRECISION OPTICS CORPORATION INC. STREET 2: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440 4 1 rforkey_f4-092612.xml FORM 4 X0306 4 2012-09-28 0 0000867840 PRECISION OPTICS Corp INC PEYE 0000898388 FORKEY RICHARD E PRECISION OPTICS CORPORATION, INC. 22 EAST BROADWAY GARDNER MA 01440 1 0 0 0 Common Stock, $0.01 par value 2012-09-28 4 P 0 27778 0.90 A 212993 D Warrants 1.25 2012-09-28 4 P 0 19445 0.90 A 2012-09-28 2017-09-28 Common Stock 19445 19445 D The 27,778 shares of common stock and warrants to purchase 19,445 shares of common stock were purchased in a private placement at a price of $0.90 per unit. Each unit consisted of one share of common stock and 70% warrant coverage. /s/ Jack P. Dreimiller as attorney in fact 2012-10-01