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13G
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CUSIP No. 461148 10 8
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Page 2 of 7
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1.
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Name of Reporting Person:
Norman Hugh Pond and Natalie Pond Trust DTD 12/23/80
Pond 1996 Charitable Remainder Unitrust
Norman H. Pond as an individual
Natalie Pond as an individual
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I.R.S. Identification Nos. of above persons (entities only):
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2.
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Check the Appropriate Box if a Member of a Group:
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(a)
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o
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(b)
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x
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3.
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SEC Use Only:
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4.
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Citizenship or Place of Organization:
USA
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Number of
Shares
Beneficially
Owned by
Each Reporting
Person With
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5.
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Sole Voting Power:
101,690
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6.
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Shared Voting Power:
958,885
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7.
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Sole Dispositive Power:
101,690
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8.
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Shared Dispositive Power:
958,885
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9.
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Aggregate Amount Beneficially Owned by Each Reporting Person:
1,060,575
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10.
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Check if the Aggregate Amount in Row (9) Excludes Certain Shares:
o
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11.
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Percent of Class Represented by Amount in Row (9):
6.2%
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12.
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Type of Reporting Person:
IN
OO
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Page 3 of 7
INSTRUCTIONS FOR SCHEDULE 13G
Instructions for Cover Page
(1)
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Names and I.R.S. Identification Numbers of Reporting Persons
Furnish
the full legal name of each person for whom the report is filedi.e., each
person required to sign the schedule itselfincluding each member of a
group. Do not include the name of a person required to be identified in
the report but who is not a reporting person. Reporting persons that are
entities are also requested to furnish their I.R.S. identification
numbers, although disclosure of such numbers is voluntary, not mandatory
(see SPECIAL INSTRUCTIONS FOR COMPLYING WITH SCHEDULE 13G below).
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(2)
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If any of the shares beneficially owned by a reporting person are held as
a member of a group and that membership is expressly affirmed, please
check row 2(a). If the reporting person disclaims membership in a group
or describes a relationship with other persons but does not affirm the
existence of a group, please check row 2(b) [unless it is a joint filing
pursuant to Rule 13d1(k)(1) in which case it may not be necessary to check
row 2(b)].
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(3)
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The third row is for SEC internal use; please leave blank.
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(4)
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Citizenship or Place of Organization
Furnish citizenship if the named
reporting person is a natural person. Otherwise, furnish place of
organization.
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(5)-(9),
(11)
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Aggregate Amount Beneficially Owned by Each Reporting
Person, Etc.
Rows (5) through (9) inclusive, and (11) are to
be completed in accordance with the provisions of Item 4 of
Schedule 13G. All percentages are to be rounded off to the
nearest tenth (one place after decimal point).
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(10)
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Check if the aggregate amount reported as beneficially owned in row (9)
does not include shares as to which beneficial ownership is disclaimed
pursuant to Rule 13d-4 [17 CFR 240.13d-4] under the Securities Exchange
Act of 1934.
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(12)
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Type of Reporting Person
Please classify each reporting person
according to the following breakdown (see Item 3 of Schedule 13G) and
place the appropriate symbol on the form:
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Category
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Symbol
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Broker Dealer
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BD
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Bank
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BK
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Insurance Company
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IC
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Investment Company
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IV
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Investment Adviser
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IA
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Employee Benefit Plan, Pension Fund, or Endowment Fund
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EP
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Parent Holding Company/Control Person
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HC
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Savings Association
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SA
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Church Plan
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CP
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Corporation
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CO
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Partnership
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PN
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Individual
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IN
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Other
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OO
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Notes:
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Attach as many copies of the second part of the cover page as are
needed, one reporting person per page.
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Filing persons may, in order to avoid unnecessary duplication, answer
items on the schedules (Schedule 13D, 13G or 14D1) by appropriate cross
references to an item or items on the cover page(s). This approach may
only be used where the cover page item or items provide all the disclosure
required by the schedule item. Moreover, such a use of a cover page item
will result in the item becoming a part of the schedule and accordingly
being considered as filed for purposes of Section 18 of the Securities
Exchange Act or otherwise subject to the liabilities of that section of
the Act.
Page 4 of 7
Reporting persons may comply with their cover page filing
requirements by filing either completed copies of the blank forms
available from the Commission, printed or typed facsimiles, or computer
printed facsimiles, provided the documents filed have identical formats to
the forms prescribed in the Commissions regulations and meet existing
Securities Exchange Act rules as to such matters as clarity and size
(Securities Exchange Act Rule 12b-12).
SPECIAL INSTRUCTIONS FOR COMPLYING WITH SCHEDULE 13G
Under Sections 13(d), 13(g), and 23 of the Securities Exchange Act of 1934 and
the rules and regulations thereunder, the Commission is authorized to solicit
the information required to be supplied by this schedule by certain security
holders of certain issuers.
Disclosure of the information specified in this schedule is mandatory, except
for I.R.S. identification numbers, disclosure of which is voluntary. The
information will be used for the primary purpose of determining and disclosing
the holdings of certain beneficial owners of certain equity securities. This
statement will be made a matter of public record. Therefore, any information
given will be available for inspection by any member of the public.
Because of the public nature of the information, the Commission can use it for
a variety of purposes, including referral to other governmental authorities or
securities self-regulatory organizations for investigatory purposes or in
connection with litigation involving the Federal securities laws or other
civil, criminal or regulatory statutes or provisions. I.R.S. identification
numbers, if furnished, will assist the Commission in identifying security
holders and, therefore, in promptly processing statements of beneficial
ownership of securities.
Failure to disclose the information requested by this schedule, except for
I.R.S. identification numbers, may result in civil or criminal action against
the persons involved for violation of the Federal securities laws and rules
promulgated thereunder.
GENERAL INSTRUCTIONS
A.
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Statements filed pursuant to Rule 13d-1(b) containing the information
required by this schedule shall be filed not later than February 14
following the calendar year covered by the statement or within the time
specified in Rules 13d-1(b)(2) and 13d2(c). Statements filed pursuant to
Rule 13d-1(c) shall be filed within the time specified in Rules 13d-1(c),
13d-2(b) and 13d-2(d). Statements filed pursuant to Rule 13d-1(d) shall
be filed not later than February 14 following the calendar year covered by
the statement pursuant to Rules 13d-1(d) and 13d-2(b).
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B.
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Information contained in a form which is required to be filed by rules
under section 13(f) (15 U.S.C. 78m(f)) for the same calendar year as that
covered by a statement on this schedule may be incorporated by reference
in response to any of the items of this schedule. If such information is
incorporated by reference in this schedule, copies of the relevant pages
of such form shall be filed as an exhibit to this schedule.
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C.
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The item numbers and captions of the items shall be included but the text
of the items is to be omitted. The answers to the items shall be so
prepared as to indicate clearly the coverage of the items without
referring to the text of the items. Answer every item. If an item is
inapplicable or the answer is in the negative, so state.
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Page 5 of 7
Item 1.
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(a)
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Name of Issuer: Intevac, Inc.
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(b)
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Address of Issuers Principal Executive Offices:
3560 Bassett Street
Santa Clara, CA 95054-2704
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Item 2.
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(a)
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Name of Person Filing:
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Norman Hugh Pond and Natalie Pond Trust DTD 12/23/80
Pond 1996 Charitable Remainder Unitrust
Norman H. Pond as an individual
Natalie Pond as an individual
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(b)
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Address of Principal Business Office or, if none, Residence:
11635 Jessica Lane
Los Altos, CA 94024
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(c)
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Citizenship: USA
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(d)
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Title of Class of Securities: Common Stock
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(e)
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CUSIP Number: 461148 10 8
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Item 3.
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If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b)
or (c), check whether the person filing is a:
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(a)
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o
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Broker or dealer registered under section 15 of the Act (15
U.S.C. 78o)
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(b)
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o
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Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c)
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(c)
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o
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Insurance company as defined in section 3(a)(19) of the Act (15
U.S.C. 78c)
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(d)
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o
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Investment company registered under section 8 of the Investment
Company Act of 1940 (15 U.S.C. 80a-8)
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(e)
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o
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An investment advisor in accordance with §240.13d-1(b)(1)(ii)(E);
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(f)
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o
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An employee benefit plan or endowment fund in accordance with
§240.13d-1(b)(1)(ii)(F);
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(g)
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o
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A parent holding company or control person in accordance with
§240.13d-1(b)(1)(ii)(G);
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(h)
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o
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A savings associations as defined in Section 3(b) of the Federal
Deposit Insurance Act (12 U.S.C. 1813);
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(i)
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o
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A church plan that is excluded from the definition of an
investment company under section 3(c)(14) of the Investment Company
Act of 1940 (15 U.S.C. 80a-3);
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(j)
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o
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Group, in accordance with §240.13d-1(b)(1)(ii)(J)
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Item 4. Ownership
Provide the following information regarding the aggregate number and percentage
of the class of securities of the issuer identified in Item 1.
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(a)
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Amount beneficially owed: 1,060,575
(1)(2)
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(b)
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Percent of class: 6.2%
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(c)
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Number of shares as to which the person has:
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(i)
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Sole power to vote or to direct the vote 101,690
(1)
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Page 6 of 7
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(ii)
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Shared power to vote or to direct the vote 958,885
(2)
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(iii)
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Sole power to dispose or to direct the disposition of 101,690
(1)
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(iv)
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Shared power to dispose or to direct the disposition of 958,885
(2)
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Instruction.
For computations regarding securities which represent a right to
acquire an underlying security
see
§
240.13d3(d)(1).
Item 5. Ownership of Five Percent or Less of a Class
If this statement is being filed to report the fact that as of the date hereof
the reporting person has ceased to be the beneficial owner of more than five
percent of the class of securities, check the following
o
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Instruction:
Dissolution of a group requires a response to this item.
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Item 6.
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Ownership of More than Five Percent on Behalf of Another Person
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If any other person is known to have the right to receive or the power to
direct the receipt of dividends from, or the proceeds from the sale of, such
securities, a statement to that effect should be included in response to this
item and, if such interest relates to more than five percent of the class, such
person should be identified. A listing of the shareholders of an investment
company registered under the Investment Company Act of 1940 or the
beneficiaries of employee benefit plan, pension fund or endowment fund is not
required.
NOT APPLICABLE
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Item 7.
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Identification and Classification of the Subsidiary Which
Acquired the Security Being Reported on By the Parent Holding
Company
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If a parent holding company has filed this schedule, pursuant to Rule
13d-1(b)(ii)(G), so indicate under Item 3(g) and attach an exhibit stating the
identity and the Item 3 classification of the relevant subsidiary. If a parent
holding company has filed this schedule pursuant to Rule 13d-1(c) or Rule
13d-1(d), attach an exhibit stating the identification of the relevant
subsidiary.
NOT APPLICABLE
Item 8. Identification and Classification of Members of the Group
If a group has filed this schedule pursuant to
§
240.13d-1(b)(1)(ii)(J), so
indicate under Item 3(j) and attach an exhibit stating the identity and Item 3
classification of each member of the group. If a group has filed this schedule
pursuant to
§
240.13d-1(c) or
§
240.13d-1(d), attach an exhibit stating the
identity of each member of the group.
NOT APPLICABLE
Item 9. Notice of Dissolution of Group
Notice of dissolution of a group may be furnished as an exhibit stating the
date of the dissolution and that all further filings with respect to
transactions in the security reported on will be filed, if required, by members
of the group, in their individual capacity. See Item 5.
NOT APPLICABLE
Item 10. Certification
NOT APPLICABLE
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(1)
Includes 63,333 shares issuable upon the exercise by Norman H. Pond of
stock options to purchase shares of Common Stock which are exercisable within
60 days.
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(2)
Includes 776,528 shares held in the Norman Hugh Pond and Natalie Pond Trust
DTD 12/23/80 and 182,357 shares held in the Pond 1996 Charitable Remainder
Unitrust. Shared power held by both trustees in both trusts.
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Page 7 of 7
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify
that the information set forth in this statement is true, complete and correct.
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Date: February 13, 2004
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Norman Hugh Pond and Natalie Pond Trust DTD 12/23/80
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By:
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/s/ Norman H. Pond
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Norman H. Pond, Trustee
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By:
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/s/ Natalie Pond
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Natalie Pond, Trustee
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Pond 1996 Charitable Remainder Trust
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By:
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/s/ Norman H. Pond
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Norman H. Pond, Trustee
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By:
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/s/ Natalie Pond
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Natalie Pond, Trustee
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/s/ Norman H. Pond
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Norman H. Pond, individually
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/s/ Natalie Pond
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Natalie Pond, individually
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The original statement shall be signed by each person on whose behalf the
statement is filed or his authorized representative. If the statement is
signed on behalf of a person by his authorized representative other than an
executive officer or general partner of the filing person, evidence of the
representatives authority to sign on behalf of such person shall be filed with
the statement; provided, however, that a power of attorney for this purpose
which is already on file with the Commission may be incorporated by reference.
The name and any title of each person who signs the statement shall be typed or
printed beneath his signature.
NOTE:
Schedules filed in paper format shall include a signed original and five
copies of the schedule, including all exhibits.
See
§240.13d-7 for other
parties for whom copies are to be sent.
Attention: Intentional misstatements or omissions of fact constitute Federal
criminal violations (See 18 U.S.C. 1001)