-----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, VsxOMDB4NBPE90xpzUw7F1t1Vp6PbH3aTmVcLXQA5y8LWaeup7qpUruQrMjEIwNE yYGK3PHyrRrHkmNQRfj2cA== 0000946924-03-000005.txt : 20030130 0000946924-03-000005.hdr.sgml : 20030130 20030130161418 ACCESSION NUMBER: 0000946924-03-000005 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020627 FILED AS OF DATE: 20030130 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: DRAKE NINA G CENTRAL INDEX KEY: 0001199227 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 3 MAIL ADDRESS: STREET 1: 1003 WILD PLUM ALLEY CITY: KLAMATH FALLS STATE: OR ZIP: 97601 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: KLAMATH FIRST BANCORP INC CENTRAL INDEX KEY: 0000946924 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 931180440 STATE OF INCORPORATION: OR FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-26556 FILM NUMBER: 03532200 BUSINESS ADDRESS: STREET 1: 540 MAIN ST CITY: KLAMATH FALLS STATE: OR ZIP: 97601 BUSINESS PHONE: 5418823444 MAIL ADDRESS: STREET 2: 540 MAIN STREET CITY: KLAMATH STATE: OR ZIP: 97601 3 1 ngd_f3.txt NINA DRAKE - FORM 3 ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response.........0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 (Print of Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* Drake Nina G. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 1003 Wild Plum Alley - -------------------------------------------------------------------------------- (Street) Klamath Falls Oregon 97601 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) 06/27/2002 ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol Klamath First Bancorp, Inc. (KFBI) ________________________________________________________________________________ 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) |_| Director |_| 10% Owner |X| Officer (give title below) |_| Other (specify below) Vice President - Human Resources ____________________________________________________________________ ________________________________________________________________________________ 6. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 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 Beneficially Owned ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ None - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Securities: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ None - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: - --------------------------------------------- ----------------------- **Signature of Reporting Person Date * If the form is filed by more than one reporting person, see Instruction 5(b)(v). ** 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. -----END PRIVACY-ENHANCED MESSAGE-----