EX-99.6 11 a2136327zex-99_6.htm EXHIBIT 99.6
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EXHIBIT 99.6


PRECISION OPTICS CORPORATION, INC.
NOMINEE HOLDER CERTIFICATION
FOR RIGHTS TO ACQUIRE COMMON STOCK

        The undersigned, a bank, broker, trustee, depositary or other nominee of rights ("Rights") to purchase shares of common stock, par value $.01 per share ("Common Stock"), of Precision Optics Corporation, Inc., a Massachusetts corporation (the "Company"), pursuant to the rights offering described and provided for in the Company's prospectus dated                         , 2004 (the "Prospectus"), hereby certifies to the Company and to EquiServe Trust Company, N.A., as subscription agent for the offering of Rights, that (1) the undersigned has exercised the number of Rights specified below pursuant to the basic subscription privilege (as described in the Prospectus) and has elected to purchase the number of additional shares of Common Stock specified below pursuant to the oversubscription privilege (as described in the Prospectus) on behalf of beneficial owners of Rights (each of whom is a resident of the United States or a foreign holder that has satisfied the terms and conditions for exercise described in the Prospectus), listing separately below each such exercised basic subscription privilege and the number of shares of Common Stock subscribed for pursuant to such oversubscription privilege (without identifying any such beneficial owner) and (2) each such beneficial owner's basic subscription privilege has been exercised in full if it is exercising its oversubscription privilege:

 
  NUMBER OF SHARES OF COMMON STOCK OWNED ON
THE RECORD DATE

  RIGHTS EXERCISED PURSUANT TO BASIC
SUBSCRIPTION PRIVILEGE

  NUMBER OF SHARES SUBSCRIBED FOR PURSUANT
TO OVERSUBSCRIPTION PRIVILEGE

1.            
2.            
3.            
4.            
5.            

Provide the following information if applicable:

    
Depository Trust Company ("DTC")
Participant Number
      
DTC Basic Subscription Confirmation Number(s)

PARTICIPANT

 

 
By:      
 
Name:
Title:
   



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PRECISION OPTICS CORPORATION, INC. NOMINEE HOLDER CERTIFICATION FOR RIGHTS TO ACQUIRE COMMON STOCK