UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Warrant (Right to Buy) | (1) | 03/14/2011 | Series A Preferred Stock | 150,000 | $ 10 | D | |
Series A Preferred Stock | (2) | (2) | Common Stock | 300,683 | $ (2) | D | |
Series B Preferred Stock | (3) | (3) | Common Stock | 433,775 | $ (3) | D | |
Class B Common Stock | (3) | (3) | Common Stock | 4,700,000 | $ (3) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MICROVISION INC 19910 NORTH CREEK PARKWAY BOTHELL, WA 98011 |
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Microvision, Inc. By: Richard A. Raisig, Chief Financial Officer | 07/22/2004 | |
**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). |
(1) | The Series A Warrants are immediately exercisable. |
(2) | Each share of Series A Preferred Stock is currently convertible into (10/8.78) shares of Common Stock and will automatically convert into such amount of Common Stock upon the closing of the Issuer's Initial Public Offering, for no additional consideration. |
(3) | Each share of Series B Preferred Stock and Class B Common Stock is currently convertible into 1 share of Common Stock and will automatically convert into such amount of Common Stock upon the closing of the Issuer's Initial Public Offering, for no additional consideration. |