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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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*
Underwood Jeffrey K.
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(Last) (First) (Middle)
5533 Townsend Warbler Drive
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(Street)
Wake Forest NC 27587
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(City) (State) (Zip)
February 4, 2000
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2. Date of Event Requiring Statement (Month/Day/Year)
###-##-####
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
Rent-Way, Inc. RWY
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4. Issuer Name and Ticker or Trading Symbol
Officer - Senior Vice President, Operations
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Vice President, Operations
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6. If Amendment, Date of Original (Month/Day/Year)
October 25, 1999
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7. Individual or Joint/Group Filing (Check applicable line)
[x] Form Filed by One Reporting Person
[_] Form Filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4)
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<S> <C> <C> <C>
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Over)
(Form 3-07/98)
<PAGE>
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Rent-Way, Inc. Com. Stk. (See Note) 02/05/03 Stock Option 20,000 22.00 (D)
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(*Note: 10,000 shares are currently vested; 10,000 shares vest on 2/5/00)
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Rent-Way, Inc. Com. Stk. (See Note) 02/08/04 Stock Option 15,000 27.875 (D)
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(*Note: 4,999 shares vest on 11/1/00; 5,000 shares vest on 11/1/01; 5,001 shares vest on 11/1/02)
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Rent-Way, Inc. Com. Stk. (See Note) 09/13/04 Stock Option 70,000 22.1875 (D)
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(*Note: 23,333 shares vest on 9/13/2000; 23,333 shares vest on 9/13/2001; 23,334 shares vest on 9/13/2002)
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</TABLE>
Explanation of Responses:
/s/ Jeffrey K. Underwood February 4, 2000
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**Signature of Reporting Person 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.
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