FORM 5
Check box if no longer Form 3 Holdings Reported Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
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OMB APPROVAL |
OMB
Number: 3235-0362 |
1. Name and Address
of Reporting Person Hines, Gerald A. (Last) (First) (Middle)
(Street)
(City)
(State) (Zip) |
2. Issuer Name and Ticker Certegy,
Inc.
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4. Statement for
Month/Year
5. If Amendment, Date
of |
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Director |
10% Owner |
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X Form Filed by
One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of |
2. Transaction
Date |
2A. Deemed |
3. Transaction |
4. Securities Acquired (A) |
5. Amount of |
6. Owner- |
7. Nature of |
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Amount |
(A) or (D) |
Price |
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Common Stock |
2/12/2002 |
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A |
16,000 |
A |
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21,393 |
D |
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Common Stock |
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164.73 |
I |
By 401(K) Plan |
Total: |
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21,557.73 |
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* If the form is filed by more than one reporting person, see instruction 4(b)(v).
Table II -
Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Derivative
Security |
2. Conver sion or Exercise Price of Derivative Security |
3. Transaction Date |
3A. Deemed Execution Date,
if any (Month/ |
4. Transaction Code |
5. Number of Derivative
Securities Acquired (A) or Disposed of (D) |
6. Date Exercisable and
Expiration Date |
7. Title and Amount of
Underlying Securities |
8. Price of Derivative
Security |
9. Number of Derivative
Securities Beneficially Owned at End of Year |
10.Ownership of Derivative
Security: |
11. Nature of Indirect
Beneficial Ownership |
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(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares |
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Stock
Option |
$34.96 |
2/12/2002 |
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A |
49,962 |
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(1) |
2/12/2012 |
Common Stock |
49,962 |
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49,962 |
D |
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Explanation of Responses: (1) 21,462 options vested on the date of grant, with the remaining 28,500 shares vesting in three equal installments on each of the first, second and third anniversaries of the date of grant.
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*Gerald A. Hines ** Signature of Reporting Person |
1/13/03 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.
If space provided is
insufficient, see Instruction 6
for procedure.
http://www.sec.gov/divisions/corpfin/forms/form5.htm
Last update: 09/03/2002