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OMB APPROVAL
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OMB Number 3235-0362
Expires: January 31, 2005
Estimated average burden
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
[_] Form 3 Holdings Reported
[X] Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
Chitayat Jack
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(Last) (First) (Middle)
1133 Park Avenue, Apt. 1W
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(Street)
New York NY 10128
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Liquidmetal Technologies (LQMT)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December 31, 2002
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
_______________
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7. Individual or Joint/Group Filing
(Check applicable line)
[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
2A. 4. Amount of Owner-
Deemed Securities Acquired (A) or Securities ship
Execu- Disposed of (D) Beneficially Form: 7.
tion (Instr. 3, 4 and 5) Owned at End Direct Nature of
2. Date, 3. ---------------------------- of Issuer's (D) or Indirect
1. Transaction if any Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date (Month/ Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Day/Year) (Instr. 8) (D) and 4) (Instr.4)(Instr. 4)
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Liquidmetal Technologies
Common Stock 12/19/02 J(1) 1,289,734(1) A 1,361,057 D
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Held by J.
Holdsworth
Liquidmetal Technologies Capital,
Common Stock 12/19/02 J(1) 398,365(1) A 519,332 I Ltd.
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Held by
Wesley
Liquidmetal Technologies Invest-
Common Stock 12/19/02 J(1) 717,058(1) A 717,058 I ments, Inc
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* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
(1) Reflects change in form of beneficial ownership of 2,505,157 shares as a
result of pro rata distribution by ATI Holdings, LLC and Cook Street, LLC.
These shares have already been previously reported as beneficially owned by the
reporting person, and therefore these transactions do not represent an increase
in the number of shares beneficially owned. The amended Form 3 filed on
December 18, 2002 incorrectly overstated by 100,000 the number of shares in
which the reporting person held through ATI Holdings LLC. This overstatement
has been corrected above.
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Over)
(Form 3/99)
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or 3A. Derivative 6. of Underlying 8. ities Secur- of
Exer- Deemed Securities Date Securities Price Bene- ity: In-
cise 3. Ex- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- ecution 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Date, Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date if any action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Liquidmetal
Option to Technologies
purchase Common
common stock $9.955 01/02/03 A4 10,000 * 01/02/13 Stock 10,000 D
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Explanation of Responses:
* 2,000 shares exercisable on each of January 2, 2004, 2005, 2006, 2007, and
2008.
/s/ Curt P. Creely February 14, 2003
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CURT P. CREELY AS ATTORNEY IN FACT FOR Date
JACK CHITAYAT
*** 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 provided is insufficient, see Instruction 6 for procedure.