-----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, T2Ku0WPt5DsvLrUvs7d9jo0LYocBblgrFYo/IRAHU8Ko8S4dGsggcX2A5VG2GK1j 777vcOw+3la2rqo1xYfrxA== 0001144204-03-000109.txt : 20030114 0001144204-03-000109.hdr.sgml : 20030114 20030113104816 ACCESSION NUMBER: 0001144204-03-000109 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030109 FILED AS OF DATE: 20030113 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTELLI CHECK INC CENTRAL INDEX KEY: 0001040896 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 113234779 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15465 FILM NUMBER: 03511740 BUSINESS ADDRESS: STREET 1: 775 PARK AVE CITY: HUNTINGTON STATE: NY ZIP: 11743 BUSINESS PHONE: 5164212011 MAIL ADDRESS: STREET 1: 775 PARK AVENUE STREET 2: SUITE 340 CITY: HUNTINGTON STATE: NY ZIP: 11743 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: COHEN TODD CENTRAL INDEX KEY: 0001099381 RELATIONSHIP: OWNER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 5 VIOLET DRIVE CITY: HUNTINGTON STATION STATE: NY ZIP: 11746 4 1 doc1.txt OMB APPROVAL OMB NUMBER 3235-0287 EXPIRES: JANUARY 31, 2005 ESTIMATED AVERAGE BURDEN HOURS PER RESPONSE 0.5 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* - -------------------------------------------------------------------------------- (Last) (First) (Middle) Cohen Todd Jay - -------------------------------------------------------------------------------- (Street) PO Box 20054 - -------------------------------------------------------------------------------- (City) (State) (Zip) Huntington Station New York 11746 ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Intelli-Check, Inc. (IDN) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year January 9, 2003 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [X] 10% Owner [ ] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship 2A. 3. Disposed of (D) Befeficially Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Owned Follow- Direct Nature of Trans- Executin Code ------------------------------- ing Reported (D) or Indirect 1. action Date, (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date if any ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) and 4) (Instr.4)(Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, $.01 par value 01/09/03 S 1,000 D $7.77 - ----------------------------------------------------------------------------------------------------------------------------------- 01/09/03 S 800 D $7.76 - ----------------------------------------------------------------------------------------------------------------------------------- 01/09/03 S 1,200 D $7.75 - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- 740,800 D ===================================================================================================================================
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, see Instruction 4(b)(v). (Over) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. 10. Number Owner- of ship Deriv- Form 2. ative of Conver- 5. 7. Secur- Deriv- 11. sion Number of Title and Amount ities ative Nature or 3A. Derivative 6. of Underlying 8. Bene- Secur- of Exer- Deemed 4. Securities Date Securities Price ficially ity: In- cise 3. Exe- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Owned Direct direct Price Trans- cution action or Disposed Expiration Date ---------------- Deriv- Following (D) or Bene- 1. of action Date, Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative (Month/ Month/ 8) 4 and 5) Date Expira- Number ity action (I) ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr.(Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ----------------------------------------------------------------------------------------------------------------------------------- Rights $8.50 01/09/03 D 300* - ---------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $3.00 07/15/99 A 110,000 Current 07/15/04 Stock 110,000 - ---------------------------------------------------------------------------------------------------------------------------------- Common Rights $8.50 10/05/01 A 85,600 Current 04/04/03 Stock 85,600 - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- 195,600 D =================================================================================================================================== Explanation of Responses: * Upon a transfer of shares to which the rights attach the rights are no longer exercisable. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. By: /s/ Todd Cohen Jan. 13, 2003 -------------------------------- --------------- ***Signature of Reporting Person Date Todd Cohen
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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a current valid OMB Number. -----END PRIVACY-ENHANCED MESSAGE-----