| FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | ||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
MINE SAFETY APPLIANCES CO [ MSA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/06/2003 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock, no par value | 06/06/2003 | M | 245 | A | 18.7917 | 14,023 | D | |||
| Common Stock, no par value | 06/06/2003 | F | 108 | D | 42.6 | 13,915 | D | |||
| Common Stock, no par value | 06/06/2003 | M | 2,040 | A | 20.1875 | 15,955 | D | |||
| Common Stock, no par value | 06/06/2003 | F | 966 | D | 42.6 | 14,989 | D | |||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 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 (Instr. 8) | 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: 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 | ||||||||
| Stock Option | 18.7917 | 06/06/2003 | M | 245 | 08/25/1997 | 02/25/2007 | Common Stock | 3,810 | $18.7917 | 0 | D | ||||
| Stock Option | 20.1875 | 06/06/2003 | M | 2,040 | 09/10/1998 | 03/10/2008 | Common Stock | 4,080 | $20.1875 | 2,040 | D | ||||
| Explanation of Responses: |
| Douglas K. McClaine, Attorney-in-Fact for William M. Lambert | 06/10/2003 | |
| ** 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. | ||
To Sign and File Reports under Section 16(a)
of the Securities Exchange Act of 1934,
under Rule 144 or any other Filings Required
Under the Federal Securities Laws
With Respect to Securities of Mine Safety Appliances Company
KNOW ALL MEN BY THESE PRESENTS, that the undersigned hereby constitutes and appoints Douglas K. McClaine or the General Counsel of Mine Safety Appliances Company ("MSA"), Dennis L. Zeitler or the Vice President-Finance of MSA and Nelson W. Winter, and each of them, his or her true and lawful attorneys-in-fact and agents, with full power of substitution, for the undersigned and in the undersigned's name, place and stead, to sign any and all reports of the undersigned under Section 16(a) of the Securities Exchange Act of 1934, under Rule 144 or any other filings required under the Federal Securities Laws with respect to securities of MSA, and to file the same with
the Securities and Exchange Commission, granting unto said attorneys-in-fact and agents, and each of them, full power and authority to do and perform each and every act and thing requisite and necessary to be done as fully to all intents and purposes as the undersigned might or could do in person, hereby ratifying and confirming all that said attorneys-in-fact and agents or any of them, or his, her or their substitute or substitutes, may lawfully do or cause to be done by virtue hereof. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming any of the undersigned's responsibilities to comply with the Federal Securities Laws.
This Power of Attorney shall remain in effect unless and until notice of its revocation shall have been filed by the undersigned with the Securities and Exchange Commission.
&nbs p; IN WITNESS WHEREOF, the undersigned has executed and delivered this Power of Attorney the date set forth below.
Date: August 27, 2002
SIGNATURE: /s/William M. Lambert
PRINT NAME: William M. Lambert