-----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, P303Np765qu3Q6XMAGoA4dpwuEKziRq+jTTW8JSr79NbDExip/UwlC4os+XigfGX TiOBxSC3onwwBLtHh/dgtg== 0001144204-07-067680.txt : 20071214 0001144204-07-067680.hdr.sgml : 20071214 20071214170624 ACCESSION NUMBER: 0001144204-07-067680 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: Green Ann C W CENTRAL INDEX KEY: 0001411838 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21609 FILM NUMBER: 071308009 BUSINESS ADDRESS: BUSINESS PHONE: (732) 741-1500 MAIL ADDRESS: STREET 1: 636 RIVER ROAD 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 v097354_ex.xml X0202 4 2007-12-12 0 0001025771 CHASE PACKAGING CORP CPKA 0001411838 Green Ann C W 636 RIVER ROAD FAIR HAVEN NJ 07704 0 1 0 0 CFO and Assistant Secretary Common Stock 2007-12-12 4 J 0 6000 A 307275 D Series A 10% Convertible Preferred Stock 0.10 2007-12-12 4 J 0 12 A Common 237000 237000 D Warrants 0.15 2007-12-12 4 J 0 6000 A 2012-09-07 Common 118500 118500 D Reporting person received a total of 12 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 convertible into common shares at $0.10 per share; 500 shares of the Company's $0.10 par value Common Stock; and 500 Warrants. 143,970 common shares held in reporting person's IRA. Currently exercisable. Not applicable. /s/ Ann C W Green 2007-12-14 -----END PRIVACY-ENHANCED MESSAGE-----