-----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, Jx1ql33qUxzqAfVFjF255qu0Cyo7wzyZcIZT+DYHihDebbMQdL230VJiuNLIsfc3 2avC9sJk0z1oTVtp62NYgw== 0000912057-00-002960.txt : 20000203 0000912057-00-002960.hdr.sgml : 20000203 ACCESSION NUMBER: 0000912057-00-002960 CONFORMED SUBMISSION TYPE: 3/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000126 FILED AS OF DATE: 20000131 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: 3/A SEC ACT: SEC FILE NUMBER: 333-89989 FILM NUMBER: 517056 BUSINESS ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440-3338 BUSINESS PHONE: 9786301800 FORMER COMPANY: FORMER CONFORMED NAME: PRECISION OPTICS CORP INC DATE OF NAME CHANGE: 19600201 COMPANY DATA: COMPANY CONFORMED NAME: RANCOURT JAMES D CENTRAL INDEX KEY: 0001104222 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3/A BUSINESS ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440 BUSINESS PHONE: 9786301800 MAIL ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440 3/A 1 3/A
- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 3 WASHINGTON, D.C. 20549 OMB APPROVAL - -------- ----------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB Number: 3235-0104 Expires: December 31, 2001 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Estimated average burden Section 17(a) of the Public Utility Holding Company Act of 1935 or hours per response .... 0.5 (Print or Type Responses) Section 30(f) of the Investment Company Act of 1940 ----------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Re- 4. Issuer Name AND Ticker or Trading Symbol quiring Statement Rancourt James D. (Month/Day/Year) Precision Optics Corporation, Inc. (POCI) - ------------------------------------------------- ------------------------------------------------------------ (Last) (First) (Middle) 1/19/2000 5. Relationship of Reporting Person(s) 6. If Amendment, Date ----------------------- to Issuer (Check all applicable) of Original 3. IRS or Social Se- Director 10% Owner (Month/Day/Year) curity Number of ---- ---- 1/27/2000 22 East Broadway Reporting Person Officer (give Other (specify --------------------- - ------------------------------------------------- (Voluntary) X title below) below) 7. Individual or (Street) ---- ---- Joint/Group Filing Senior Vice President, (Check Applicable Optical Thin Films Technology Line) ----------------------------- Form filed by One X Reporting Person --- Form filed by More than One Reporting Person Gardner MA 01440 --- - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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 5(b)(v). SEC 1473 (7-97) 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 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial Expiration (Instr. 4) Exercise Form of Ownership Date Price of Deriv- (Instr. 5) (Month/Day/ Deri- ative Year) vative Security: -------------------------------------------------- Security Direct Amount (D) or Date Expir- or Indirect Exer- ation Title Number (I) cisable Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (to buy) see below 12/12/09 Common Stock 150,000 $5.00 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: Options are exercisable as follows: 30,000 on 6/12/00 30,000 on 6/12/01 30,000 on 6/12/02 30,000 on 6/12/03 30,000 on 6/12/04 /s/ James D. Rancourt 1/28/2000 ------------------------------------- ---------------------- **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). James D. Rancourt 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. Page 2 SEC 1473 (7-97)
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