UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
INITIAL STATEMENT OF 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(f)
of the Investment Company Act of 1940
(Print or Type Responses)
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Foster City LLC Statement Trading Symbol of Original
---------------------------------------- (Month/Day/Year) Intevac, Inc.- IVAC (Month/Day/Year)
(Last) (First) (Middle) December 1, 1999 ---------------------------------- 12/10/99
950 Tower Lane, Suite 800 ---------------------------- 5. Relationship of Reporting -----------------------
---------------------------------------- 3. IRS Identification Person(s) to Issuer 7. Individual or Joint/
(Street) Number of Reporting (Check all applicable) Group (Check
Foster City CA 94404 Person, if an entity Director X 10% Owner Applicable Line)
-------------------------------------- (Voluntary) ----- ----- X Form filed by
(City) (State) (Zip) ---------------------------- Officer Other ----- One Reporting
----- (give ----- (specify Person
title below) below) Form filed by
----- More than One
---------------------------------- Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Common Stock 5,600,000 D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
*If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (3-99)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deriv- ative
ative Security:
Security
------------------------------------------------- Direct
Date Expira- Amount or (D) or
Exercis- tion Title Number Indirect (I)
able Date of Shares (Instr. 5)
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Explanation of Responses:
/s/ JOHN CHAPIN 2/22/00
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**Signature of Reporting Person Date
**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. Page 2
If space is insufficient, See Instruction 6 for procedure. SEC 1473 (3-99)
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently value OMB
Number.
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