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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 | $ 7.5 | 05/04/2005 | M | 4,900 | (1) | 08/02/2010 | Common Stock | 4,900 | (1) | 79,100 | D | ||||
Stock Option Right-to-Buy | $ 7.5 | 05/05/2005 | M | 31,300 | (4) | 08/02/2010 | Common Stock | 31,300 | (4) | 47,800 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BLOSS DAVID A SR C/O CIRCOR INTERNATIONAL, INC. 25 CORPORATE DRIVE, SUITE 130 BURLINGTON, MA 01803 |
X | CEO, Chairman & President |
Stephen J. Carriere, Attorney in Fact | 05/05/2005 | |
**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 105,000 options by the issuer to the reporting person on August 2, 2000. The 4,900 options exercised are a portion of the 21,000 options that became exercisable on August 2, 2002. 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 500 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 the 105,000 options by the issuer to the reporting person on August 2, 2000. The 31,300 options are a portion of the 42,000 options that became exercisable on August 2, 2002 and 2003. These options convert into shares of the issuer's common stock on a one-for-one basis. |