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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who 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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option Right to Buy (6) | $ 11.95 | 02/22/2005 | M | 17,800 | (1) | 09/01/2005 | Common Stock | 17,800 | (1) | 50,636 | D | ||||
Stock Option Right to Buy (6) | $ 11.95 | 02/23/2005 | M | 40,000 | (4) | 09/01/2005 | Common Stock | 40,000 | (4) | 10,636 | D | ||||
Stock Option Right to Buy (6) | $ 11.95 | 02/24/2005 | M | 10,636 | (5) | 09/01/2005 | Common Stock | 10,636 | (5) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BLOSS DAVID A SR CIRCOR INTERNATIONAL, INC. 25 CORPORATE DRIVE BURLINGTON, MA 01803 |
X | President, Chairman & CEO |
Stephen J. Carriere, Attorney-in-fact | 03/03/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | The stock options exercised herein are a portion of the grant of 68,436 options by the issuer to the reporting person on September 1, 1995. The 17,800 options exercised are a portion of the 27,374 options that became exercisable on September 1, 1996 and 1997. The options convert into shares of the issuer's common stock on a one-for-one basis. |
(2) | The transactions reported herein reflect the cashless exercise by the reporting person of stock options previously granted to the reporting person by the issuer. |
(3) | Prior to the transactions reported herein, the reporting person held 18,668 shares of the issuer's common stock directly and an additional 400 shares indirectly in his spouse's name. After consumption of these transactions, the reporting person continues to hold 18,668 shares directly and an additional 500 shares indirectly in his spouse's name. |
(4) | The stock options exercised herein are a portion of the grant of 68,436 options by the issuer to the reporting person on September 1, 1995. The 40,000 options are a portion of the 54,749 options that became exercisable on September 1, 1996, 1997, 1998, 1999 and 2000. These options convert into shares of the issuer's common stock on a one-for-one basis. |
(5) | The stock options exercised herein are a portion of the grant of 68,436 options by the issuer to the reporting person on September 1, 1995. The 10,636 options exercised are a portion of the 13,687 options that became exercisable on September 1, 2000. These options convert into shares of the issuer's common stock on a one-for-one basis. |
(6) | This amendment is filed to reflect the exercise in Table II, column 5, as "disposed" instead of as inadvertently noted as "acquired" in original filing. |