-----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, KofnZIVpxUef9GZiVRvSsMVePNTeog0p36LIAogkPj39y5tTqZK3icg+MGlg+7H0 NPcl03QCQgXmZDt1q/JLvQ== 0000950135-98-004225.txt : 19980714 0000950135-98-004225.hdr.sgml : 19980714 ACCESSION NUMBER: 0000950135-98-004225 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980611 FILED AS OF DATE: 19980713 SROS: NASD 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: 4 SEC ACT: SEC FILE NUMBER: 001-10647 FILM NUMBER: 98665171 BUSINESS ADDRESS: STREET 1: 22 EAST BROADWAY CITY: GARDNER STATE: MA ZIP: 01440-3338 BUSINESS PHONE: 5086301800 FORMER COMPANY: FORMER CONFORMED NAME: PRECISION OPTICS CORP INC DATE OF NAME CHANGE: 19600201 COMPANY DATA: COMPANY CONFORMED NAME: KHAJURIVALA KUMAR M CENTRAL INDEX KEY: 0001040742 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: O STREET 2: 252 MASSAPOAG AVE CITY: NORTH EASTON STATE: MA ZIP: 02356 MAIL ADDRESS: STREET 2: 252 MASSAPOAG AVENUE CITY: NORTH EASTON STATE: MA ZIP: 02356 4 1 PRECISION OPTICS 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------- - ------- WASHINGTON, D.C. 20549 OMB APPROVAL FORM 4 OMB NUMBER: 3235-0287 - ------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP EXPIRES: SEPTEMBER 30, 1998 ESTIMATED AVERAGE BURDEN - --- CHECK BOX IF NO LONGER HOURS PER RESPONSE..........0.5 - --- SUBJECT TO SECTION 16. FORM 4 Filed pursuant to Section 16(a) of the Securities ------------------------------- OR FORM 5 OBLIGATIONS MAY Exchange Act of 1934, Section 17(a) of the Public CONTINUE. SEE INSTRUCTION 1(b). Utility Holding 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* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer Precision Optics Corporation, Inc.(POCI) (Check all applicable) Director 10% Owner --- --- Khajurivala Kumar M. ------------------------------------------- X Officer (give title Other (specify - ----------------------------------------- 3. IRS or Social 4. Statement for --- below) --- below) (Last) (First) (Middle) Security Number Month/Year --------------------------------------------- of Reporting 6/98 V.P. of Operations Person ------------------------ --------------------------------------------- 13 Lincoln Street (Voluntary) 5. If Amendment, Date of 7. Individual or Joint/Group Filing (Check - ----------------------------------------- Original (Month/Year) Applicable Line) (Street) X Form Filed by One Reporting Person --- Form Filed by More than One Reporting Ashburnham MA 01430 --- Person - ----------------------------------------- ------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A)or 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Month/ (Instr. 8) Owned at Direct Bene- Day/ --------------------------------------- End of (D) or ficial Year) Code V Amount (A) or Price Month Indirect Owner- (D) (Instr. 3 and 4) (I) ship (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/11/98 S 5,000 D $2.50 50,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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/4(b)(v). SEC 1474 (7-96)
2 FORM 4 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of Deriv- 6. Date Exer- 7. Title and Amount of Under- Security (Instr. 3) sion or action action ative Securities Ac- cisable and Ex- lying Securities Exercise Date Code quired (A) or Dis- piration Date (Instr. 3 and 4) Price of (Month/ (Instr. 8) posed of (D) (Month/Day/ Deriv- Day/ (Instr. 3, 4 and 5) Year) ative Year) Security - ------------------------------------------------------------------------------------------------------------------------------------ Date Expira- Amount or Code V (A) (D) Exer- tion Title Number of cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------- 8. Price 9. Number 10. Owner- 11. Na- of of Deriv- ship ture Deriv- ative Form of of In- ative Secur- De- direct Secur- ities rivative Bene- ity Bene- Secu- ficial (Instr. ficially rity: Own- 5) Owned Direct ership at End of (D) or (Instr. 4) Month Indi- (Instr. 4) rect (I) (Instr.4) - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- Explanation of Responses: **Intentional misstatements or omissions of facts constitute Federal /s/ Kumar M. Khajurivala 7/7/98 Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C 78ff(a). ------------------------------- ------------------- **Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Kumar M. Khajurivala 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 1474 (7-96)
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