SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|555 TURNPIKE STREET|
|C/O CASUALMALE RETAIL GROUP|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
CASUAL MALE RETAIL GROUP INC
[ CMRG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|EVP,Director of Store Develop.||
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||Arlene C. Feldman Attorney-in-Fact for Joseph H. Cornely, III
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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.|
This Statement confirms that the undersigned, Joseph H. Cornely, III,
has authorized and designated David A. Levin, Dennis R. Hernreich and Arlene
C. Feldman to execute and file on the undersigned's behalf all Forms 3, 4 and
5 (including any amendments thereto) that the undersigned may be required to
file with the United States Securities and Exchange Commission as a result of
the undersigned's ownership of or transactions in securities of Casual Male
Retail Group, Inc. The authority of David A. Levin, Dennis R. Hernreich and
Arlene C. Feldman under this Statement shall continue until the undersigned is
no longer required to file Forms 3, 4 and 5 with regard to the undersigned's
ownership of or transactions in the securities of Casual Male Retail Group,
Inc., unless earlier revoked in writing. The undersigned acknowledges that
David A. Levin, Dennis R. Hernreich and Arlene C. Feldman are not assuming any
of the undersigned's responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934.
Date: December 8, 2003 By: /s/ Joseph H. Cornely, III
Name: Joseph H. Cornely, III
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