SEC FORM
3
SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
C/O CIRCOR INTERNATIONAL, INC. |
35 CORPORATE DRIVE, SUITE 290 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/24/2003
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3. Issuer Name and Ticker or Trading Symbol
CIRCOR INTERNATIONAL INC
[ cir ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
VP & GM Instr. Indus. Products |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Stock Options (right to buy) |
10/29/2000
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10/29/2009 |
Common Stock |
11,200 |
9.5 |
D |
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Stock Options (right to buy) |
08/02/2001
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08/02/2010 |
Common Stock |
12,000 |
7.5 |
D |
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Stock Options (right to buy) |
10/29/2008
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10/29/2011 |
Common Stock |
8,000 |
16.32 |
D |
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Stock Options (right to buy) |
10/23/2003
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10/23/2012 |
Common Stock |
8,000 |
13.9 |
D |
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Restricted Stock Units |
03/16/2004 |
03/16/2006
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Common Stock |
2,779 |
9.447
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D |
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Restricted Stock Units |
02/13/2005 |
02/13/2007
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Common Stock |
429 |
12.7233
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D |
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Explanation of Responses: |
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Alan J. Glass, Attorney in fact |
08/04/2003 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* 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. |
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 Number. |
LIMITED POWER OF ATTORNEY
FOR
CIRCOR INTERNATIONAL, INC.
SECTION 16(a) FILINGS
Know all by these presents, that the undersigned hereby constitutes and
appoints each of David A. Bloss, Sr., Stephen J. Carriere and Alan J. Glass,
signing singly, the undersigneds true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigneds
capacity as an officer, director and/or stockholder of CIRCOR International,
Inc. (the Company), Forms 3, 4, and 5 and amendments thereto in accordance
with Section 16(a) of the Securities Exchange Act of 1934 and the rules
thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form 3,
4, or 5 or amendment thereto and timely file such form with the United States
Securities and Exchange Commission (the SEC)and any stock exchange or
similar authority;and
(3) take any other action of any type whatsoever which, in the opinion
of such attorney-in-fact, may be necessary or desirable in connection with
the foregoing authority,it being understood that the documents executed by
such attorney-in-fact on behalf of the undersigned pursuant to this Power
of Attorney shall be in such form and shall contain such terms and conditions
as such attorney-in-fact may approve.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and
powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-facts substitute or substitutes, shall
lawfully do or cause to be done by virtue of this Power of Attorney and the
rights and powers herein granted. The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in such capacity at the request
of the undersigned, are not assuming, nor is the Company assuming, any of
the undersigneds responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect
to the undersigneds holdings of and transactions in securities of the
Company, unless earlier revoked by the undersigned in a signed writing
delivered to the foregoing attorneys-in-fact. This Power of Attorney may
be filed with the SEC as a confirming statement of the authority granted herein.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 24th day of July, 2003.
Barry L. Taylor, Sr.
Person or Entity
/s/ Barry L. Taylor
Signature