FORM 3
| Washington, D.C. 20549 |
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 * Miyanaga Eiji |
2. Date of Event Requiring Statement (MM/DD/YYYY)
| 3. Issuer Name and Ticker or Trading Symbol INTEVAC INC [IVAC] |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below) | ||
5. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person ___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Beneficially Owned | |||
1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 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) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
No securities are beneficially owned. |
Reporting Owners | |||||
Reporting Owner Name / Address | |||||
Director | 10% Owner | Officer | Other | ||
Miyanaga Eiji 3560 BASSETT STREET SANTA CLARA, CA 95054 | X |
Signatures | ||
/s/ Eiji Miyanaga | 8/28/2024 | |
**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 control number. |
CONFIRMING STATEMENT
REGARDING AUTHORITY TO EXECUTE SECTION 16(A) REPORTS
This Statement confirms that the undersigned, Eiji Miyanaga, the Insider,
has authorized and designated Diane Garibaldi, Richard Blake and Andrew Chew,
and each of them, each of the foregoing is referred to as an Authorized Signer
to execute and file on the Insider's behalf any and all Forms 3, 4
and 5 including any amendments thereto that the Insider may be required to
file with the U.S. Securities and Exchange Commission as a result of the
Insider's ownership of, or transaction in, securities
of INTEVAC, INC., the Company, and to execute the documents necessary to
obtain EDGAR codes from the Securities and Exchange Commission.
The authority of the Authorized signers under this Confirming Statement shall
continue until the insider is no longer required to file Forms 3, 4 and 5 with
regard to the Insider's ownership of, or transactions in,
securities of the Company, unless earlier revoked in writing.
The Insider acknowledges that none of the Authorized signers
is assuming any of the Insider's responsibilities to comply with Section 16
of the Securities Exchange Act of 1934.
Date: August 23, 2024 Signature: /s/ Eiji Miyanaga |