SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
DARROW KURT L

(Last) (First) (Middle)
1284 N. TELEGRAPH ROAD

(Street)
MONROE MI 48162

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/09/2003
3. Issuer Name and Ticker or Trading Symbol
LA-Z-BOY INC [ LZB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Shares 1,946 I By 401(k)
Common Shares 85,292 D
Common Shares 780 I By ESOP
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to buy) 07/26/2000 07/26/2004 Common Shares 13,100 23.75 D
Stock Option (Right to Buy) 07/31/2001 07/29/2005 Common Shares 16,900 15.5 D
Stock Option (Right to Buy) 08/15/2002 08/15/2006 Common Shares 16,900 19.8 D
Stock Option (Right to Buy) 08/14/2003 08/14/2012 Common Shares 16,900 22.6 D
Stock Option (Right to Buy) 08/12/2004 08/12/2013 Common Shares 16,900 20.44 D
Explanation of Responses:
Remarks:
James P. Klarr, Attorney-in-Fact 09/17/2003
** 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 5 (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.
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