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FORM 5 OMB APPROVAL
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- ----- Check this box if no longer OMB Number: 3235-0287
subject to Section 16. Form 4 Expires: April 30, 1997
- ----- or Form 5 obligations may Estimated average burden
continue. See Instruction 1(b). hours per response .... 1.0
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- ----- Form 3 Holdings
Reported
- -----
- ----- Form 4 Transactions
Reported
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
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1. Name and Address of Reporting Person
Solomon Peter J.
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(Last) (First) (Middle)
767 Fifth Avenue, 26th Floor
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(Street)
New York NY 10022
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Monro Muffler Brake, Inc. (MNRO)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
Fiscal 2000
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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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<TABLE>
<CAPTION>
Table I-Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A)
(Instr. 3) action action or Disposed of (D)
Date Code (Instr. 3, 4 and 5)
------ (Instr. 8) --------------------------
(Month/ ----------- Amount (A) or Price
Day/ (D)
Year)
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<C> <C> <C> <C> <C> <C>
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5. Amount of 6. Ownership 7. Nature of
Securities Form: Direct Indirect
Beneficially (D) or Indirect Beneficial
Owned at End (1) (Instr. 4) Ownership
of Issuer's (Instr. 4)
Fiscal Year
(Instr. 3
and 4)
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<C> <C> <C>
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</TABLE>
Reminder: Report on a separate line for each class of securities
beneficially owned directly or indirectly. (Over)
(Print or Type Responses) SEC 2270 (3/91)
<PAGE>
FORM 5 (continued)
<TABLE>
<CAPTION>
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 2. Conver- 3. Transac- 4. Transac- 5. Number of
Security (Instr. 3) sion or tion Date tion Code Derivative
Exercise (Month/ (Instr. 8) Securities
Price of Day/ ------------ Acquired (A)
Deriv- Year) or Disposed
ative of (D) (Instr.
Security 3, 4, and 5)
-------------
(A) (D)
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<S> <C> <C> <C> <C> <C>
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Non-Employee Director Stock $7.50 8/2/99 A 3,039 N/A
Option (right to buy)
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6. Date Exer- 7. Title and Amount 8. Price of 9. Number of
cisable and Ex- of Underlying Derivative Derivative
piration Date Securities Security Securities
(Month/Day/ (Instr. 3 and 4) (Instr. 5) Beneficially
Year) ------------------- Owned at
- ------------------ Amount or End of Year
Date Expira- Title Number of (Instr. 4)
Exer- tion Shares
cisable Date
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<C> <C> <C> <C> <C> <C>
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8/2/99 8/1/09 Common Stock 3,039 N/A 3,039
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10. Ownership 11. Nature of
of Indirect
Derivative Beneficial
Security: Ownership
Direct (D) or (Instr. 4)
Indirect (I)
(Instr. 4)
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<C> <C>
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D N/A
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</TABLE>
Explanation of Responses:
**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.
---/s/ Peter J. Solomon 5/12/00
**Signature of Reporting Person Date
Page 2
SEC 2270 (3/91)
