0000879554-01-500058.txt : 20011019 0000879554-01-500058.hdr.sgml : 20011019 ACCESSION NUMBER: 0000879554-01-500058 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010630 FILED AS OF DATE: 20011011 COMPANY DATA: COMPANY CONFORMED NAME: SIROIS KEITH E CENTRAL INDEX KEY: 0001137969 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 14255 49TH STREET N BLDG 1 CITY: CLEARWATER STATE: FL ZIP: 33762 BUSINESS PHONE: 7275192000 MAIL ADDRESS: STREET 1: 14255 49TH STREET N BLDG 1 CITY: CLEARWATER STATE: FL ZIP: 33762 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CHECKERS DRIVE IN RESTAURANTS INC /DE CENTRAL INDEX KEY: 0000879554 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 581654960 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19649 FILM NUMBER: 1756981 BUSINESS ADDRESS: STREET 1: PO BOX 18800 CITY: CLEARWATER STATE: FL ZIP: 33762 BUSINESS PHONE: 7275192000 MAIL ADDRESS: STREET 1: 14255 49TH STREET NORTH BLDG I CITY: CLEARWATER STATE: FL ZIP: 33762 4 1 siroisform40601.htm <SEC-DOCUMENT>0001093976-00-000002-index

BUSINESS ADDRESS:

STREET 1: 14255 49TH STREET NORTH, BLDG. 1

CITY: CLEARWATER

STATE: FL

ZIP: 33762

BUSINESS PHONE: 7275192000

 

MAIL ADDRESS:

STREET 1: 14255 49TH STREET NORTH, BLDG. 1

CITY: CLEARWATER

STATE: FL

ZIP: 33762

STATEMENT FOR MONTH/YEAR: JUNE 2001

COMPANY DATA:

COMPANY CONFORMED NAME: KEITH E. SIROIS

CENTRAL INDEX KEY: 0001137969

STANDARD INDUSTRIAL CLASSIFICATION:

RELATIONSHIP: OFFICER

FILING VALUES:

FORM TYPE: 4

BUSINESS ADDRESS:

STREET 1: 14255 49TH STREET NORTH

STREET 2: BUILDING 1

CITY: CLEARWATER

STATE: FL

ZIP: 33762

 

 

 

 

MAIL ADDRESS:

STREET 1: 16303 DOBSON COURT

STREET 2:

CITY: TAMPA

STATE: FL

ZIP: 33647

 

 

Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

 

Title of Non-Derivative Security

Transaction Date

Transaction Code

 

Security Amount

Securities Acquired/ Disposed (A/D)

 

Securities Price

Amount Beneficially Owned at End of the Month

Ownership Direct or Indirect

 

 

Nature of Indirect Beneficial Ownership

                 

 

 

 

 

 

 

 

 

 

 

 

 

Table II Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)

 

Title of Derivative Security

Conversion or Exercise Price

Transaction Date

Transaction Code

Securities Acquired/

Disposed

Date Exercisable

Expiration Date

Title

Number of Shares

Price of Security
Number Beneficially Owned End of Month

Ownership Direct or Indirect

Nature of Indirect Beneficial Ownership

Stock Option (Right to Buy)

$5.5500

06/14/01

A

A

06/14/02

06/14/11

C

30,000*

 

45,833

D

 
                         

 

Explanation of Responses:

* Options to be vested at 10,000 on 6/14/02, 10,000 on 6/14/03, and 10,000 on 6/14/04.

 

 

 

 

______________________________________________ ______________

Signature of Reporting Person Date