-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, WXiQ0OX1AIcstI078ycNhhqnZBUfdHHb2GAxQeo3No6F312eaDjwR1KRcoTV8jQp f3glWeG6JRsdexijpr5mVQ== 0001144204-07-067676.txt : 20071214 0001144204-07-067676.hdr.sgml : 20071214 20071214170453 ACCESSION NUMBER: 0001144204-07-067676 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20071212 FILED AS OF DATE: 20071214 DATE AS OF CHANGE: 20071214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GARDNER HERBERT M CENTRAL INDEX KEY: 0000923414 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21609 FILM NUMBER: 071307984 BUSINESS ADDRESS: BUSINESS PHONE: 2125100684 MAIL ADDRESS: STREET 1: P O BOX 6199 CITY: FAIR HAVEN STATE: NJ ZIP: 07704 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CHASE PACKAGING CORP CENTRAL INDEX KEY: 0001025771 STANDARD INDUSTRIAL CLASSIFICATION: AGRICULTURE SERVICES [0700] IRS NUMBER: 931216127 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: POB 6199 STREET 2: 636 RIVER ROAD CITY: FAIRHAVEN STATE: NJ ZIP: 07704 BUSINESS PHONE: 732-741-1925 MAIL ADDRESS: STREET 1: POB 6199 STREET 2: 636 RIVER ROAD CITY: FAIRHAVEN STATE: NJ ZIP: 07704 4 1 v097340_ex.xml X0202 4 2007-12-12 0 0001025771 CHASE PACKAGING CORP CPKA 0000923414 GARDNER HERBERT M 636 RIVER ROAD FAIR HAVEN NJ 07704 1 1 1 0 Vice President Common Stock 2007-12-12 4 J 0 73500 A 1534583 D Common Stock 2007-12-12 4 J 0 5500 A 167590 I By Spouse Series A 10% Convertible Preferred Stock 0.10 2007-12-12 4 J 0 147 A Common 1247000 1247000 D Series A 10% Convertible Preferred Stock 0.10 2007-12-12 4 J 0 11 A Common 178000 178000 I By Spouse Warrants 0.15 2007-12-12 4 J 0 73500 A 2012-09-07 Common 623500 623500 D Warrants 0.15 2007-12-12 4 J 0 5500 A 2012-09-07 Common 89000 89000 I By Spouse Reporting Person received a total of 147 investment units issued by Company pursuant to debt financing transactions between reporting person and Company. Each investment unit consists of one share of Series A 10% Convertible Preferred Stock, par value $1.00 per share, stated value $100 per share; 500 shares of the Company's $0.10 par value Common Stock; and 500 Warrants. Reporting Person's spouse received a total of 11 investment units issued by Company's pursuant to debt financing transaction between reporting person and Company. Each investment unit consists of one share of Series A 10% Convertible Preferred Stock, par value $1.00 per share, stated value $100 per share; 500 shares of the Company's $0.10 par value Common Stock; and 500 Warrants. 533 investment units are held in Reporting Person's Keogh which represent 266,500 common shares, 266,500 warrants; and 533 preferred shares convertible into 533,000 common shares. Reporting person disclaims beneficial ownership of shares and warrants owned by spouse. Currently exercisable. Not applicable. /s/ Herbert M. Gardner 2007-12-14 -----END PRIVACY-ENHANCED MESSAGE-----