0001179110-13-002698.txt : 20130214
0001179110-13-002698.hdr.sgml : 20130214
20130214133239
ACCESSION NUMBER: 0001179110-13-002698
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121231
FILED AS OF DATE: 20130214
DATE AS OF CHANGE: 20130214
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GARDNER HERBERT M
CENTRAL INDEX KEY: 0000923414
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-21609
FILM NUMBER: 13610364
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: NJ
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 636 RIVER ROAD
CITY: FAIRHAVEN
STATE: NJ
ZIP: 07704
BUSINESS PHONE: 732-741-1500
MAIL ADDRESS:
STREET 1: POB 6199
STREET 2: 636 RIVER ROAD
CITY: FAIRHAVEN
STATE: NJ
ZIP: 07704
5
1
edgar.xml
FORM 5 -
X0306
5
2012-12-31
0
0
0
0001025771
CHASE PACKAGING CORP
CPKA
0000923414
GARDNER HERBERT M
P. O. BOX 463
WADING RIVER
NY
11792
1
1
1
0
Vice President
Common Stock
2012-12-28
5
G
0
607286
D
927297
D
Common Stock
167590
I
By Spouse
Series A 10% Convertible Preferred Stock
.10
2012-12-28
5
G
0
422
D
Common Stock
1628000
1628000
D
Series A 10% Convertible Preferred Stock
.10
Common Stock
289000
289000
I
By spouse
Currently exercisable.
Not applicable.
Adjusted to reflect the annual 10% stock dividend paid by the Company to all holders of Series A Convertible Preferred Stock on December 1, 2012.
Reporting person disclaims beneficial ownership of shares owned by spouse.
874 shares of Series A Convertible Preferred Stock (convertible into 874,000 Common shares) are held in IRA Rollover.
Herbert M. Gardner
2013-02-14