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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549 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(h) of the Investment Company Act of 1940 |
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1. Title of Derivative Security | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction Code | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Acquired by North American Capital Corp. pursuant to a distribution made by Primary PDC, Inc. of common stock to holders of its 11 1/2% bonds due 2006 in satisfaction of the unsecured claims held by such bondholders in connection with Primary PDC, Inc. Plan of Reorganization. | |
By North American Capital Corp. | |
Acquired by PI Industries Profit Sharing Plan & Trust, Stanley P. Roth, Trustee, pursuant to a distribution made by Primary PDC, Inc. of common stock to holders of its 11 1/2% bonds due 2006 in satisfaction of the unsecured claims held by such bondholders in connection with Primary PDC, Inc. Plan of Reorganization. | |
By Trust for benefit of self. | |
Acquired by Stanley P. Roth IRA pursuant to a distribution made by Primary PDC, Inc. of common stock to holders of its 11 1/2% bonds due 2006 in satisfaction of the unsecured claims held by such bondholders in connection with Primary PDC, Inc. Plan of Reorganization. | |
Stanley P. Roth IRA for benefit of self. | |
Shares transferred from Royal Pioneer Industries Inc. 401K FBO S. P. Roth to Stanley P. Roth IRA for benefit of self and therefore continue to be indirectly benefically owned. | |
By Royal Pioneer Industries, Inc. 401K FBO S. P. Roth. |
| Signatures | ||
Janice E. Neville for Stanley P. Roth | 04/05/2005 | |
| ** 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 4 (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 Number. | ||
Power of Attorney I, Stanley P. Roth, the undersigned (the "Reporting Person") hereby constitute and appoint LOUISE L. CAVANAUGH and JANICE E. NEVILLE as the Reporting Person's true and lawful attorneys-in-fact to: (1) execute for and on behalf of the Reporting Person, in the Reporting Person's capacity as a member of the Board of Directors of Polaroid Holding Company (the "Company"), Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder; (2) do and perform any and all acts for and on behalf of the Reporting Person which may be necessary or desirable to complete and execute any such Form 3, 4 or 5 and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorneys-in-fact, may be of benefit to, and in the best interest of, or legally required by, the Reporting Person. The Reporting Person hereby grants to such attorneys- in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the Reporting Person might or could do if personally present. The Reporting Person acknowledges that the foregoing attorneys-in- fact, in serving in such capacity at the request of the Reporting Person, are not assuming, nor is the Company assuming, any of the Reporting Persons responsibilities to comply with Section 16 of the Securities Act of 1934. This Power of Attorney shall remain in full force and effect until the Reporting Person is no longer required to file Forms 3, 4 and 5 with respect to the Reporting Persons holdings of and transactions in securities issued by the Company, unless earlier revoked by the Reporting Person in a signed writing delivered to the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the Reporting Person has caused this Power of Attorney to be executed as of this 30th day of May, 2003. /s/ Stanley P. Roth Stanley P. Roth