4 1 d4.txt FORM 4 --------------------------- ---------------------------- FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL --------------------------- Washington, D.C. 20549 ---------------------------- [_]Check this box OMB Number: 3235-0287 if no longer subject STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Expires: December 31, 2001 of Section 16. Form 4 Estimated average burden or Form 5 obligations Filed pursuant to Section 16(a) of the Securities Exchange hours per response.......0.5 may continue. See Act of 1934, Section 17(a) of the Public Utility Holding ---------------------------- Instruction 1(b). Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
(Print or Type Responses) -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* McKibben, Craig L. -------------------------------------------------------------------------------- (Last) (First) (Middle) 135 East 57th Street -------------------------------------------------------------------------------- (Street) New York, NY 10022 -------------------------------------------------------------------------------- (City) (State) (Zip) -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Ampex Corporation (AXC) -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an entity (voluntary) -------------------------------------------------------------------------------- 4. Statement for Month/Year 11/01 -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) -------------------------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [ ] 10% Owner [X] Officer (give title below) [_] Other (specify below) Vice President, Treasurer -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) [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. Transaction 3. Transaction 4. Securities Acquired (A) or 5. Amount of 6. Owner- 7. Nature of (Instr. 3) Date Code Disposed of (D) Securities ship Indirect (Month/Day) (Instr. 8) (Instr. 3, 4 and 5) Beneficially Form: Beneficial Year) Owned at End Direct Ownership of Month (D) or Indirect (I) ------------------------------------------- Code V Amount (A)or Price (Instr. 3 (Instr.4) (Instr. 4) and 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
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, see Instruction 4(b)(v). FORM 4 (continued) 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 control number. FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------------------------ Title of 2.Conver- 3. Trans- 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10.Owner- 11.Nature Derivative sion action action Derivative Exercisable and of of ship of Security or Date Code Securities and Amount Deriv- Deriv- Form In- (Instr. 3) Exer- (Month/ (Instr. Acquired (A) Expiration of ative ative of direct cise Day/ 8) or Disposed Date Under Secur- Secur- Deriv- Bene- Price Year) of(D) (Month lying ity ities ative ficial of (Instr. 3, /Day/Year) Secu (Instr. Bene- Secur- Owner- Deriv- 4 and 5) rities 5) ficially ity: ship ative . (Instr Owned Direct (Instr. Secur- and 4) at End (D) or 4 ity --------------------------------------------- of In- Month direct Code V (A) (D) Date Expira- Title Amount (Instr. (I) Exer- tion or 4) cisable Date Number of Shares ------------------------------------------------------------------------------------------------------------------------------------ Option to Class A Acquire Common (Note 1) $0.18 11/13/01 A V 75,000 06/30/02 09/30/03 Stock 75,000 0 Note 2 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: Note 1: Non-qualified stock option grant pursuant to Rule 16b-3 under the Ampex Corporation Stock Incentive Plan (the "Plan"). Note 2: The column 9 total does not include other options outstanding under the Plan, because their exercise prices and exercise periods are different. /s/ Craig L. McKibben 12/05/01 --------------------------------------------- ----------------------- **Signature of Reporting Person Date Craig L. McKibben ** 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 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.