-----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, RnCgyzjykaEvq8u+m1hKdIeRRUZKaa/ccO3Kpns+C1LNH3EeOdZ2TsXcWNmdtcgW 0k20Ry4T3AeN7Lmes88HAA== 0001144204-04-015576.txt : 20041001 0001144204-04-015576.hdr.sgml : 20041001 20041001170602 ACCESSION NUMBER: 0001144204-04-015576 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041001 FILED AS OF DATE: 20041001 DATE AS OF CHANGE: 20041001 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MANDELBAUM FRANK CENTRAL INDEX KEY: 0001099377 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-50296 FILM NUMBER: 041059392 BUSINESS ADDRESS: STREET 1: INTELLICHECK INC STREET 2: 775 PARK AVE CITY: HUNTINGTON STATE: NY ZIP: 11743 BUSINESS PHONE: 5164212011 ISSUER: 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 BUSINESS ADDRESS: STREET 1: 246 CROSSWAYS PARK WEST STREET 2: . CITY: WOODBURY STATE: NY ZIP: 11797 BUSINESS PHONE: 516-992-1900 MAIL ADDRESS: STREET 1: 246 CROSSWAYS PARK WEST STREET 2: . CITY: WOODBURY STATE: NY ZIP: 11797 4 1 v07226_form4mandelbaumex.xml X0202 4 2004-10-01 0 0001040896 INTELLI CHECK INC IDN 0001099377 MANDELBAUM FRANK 246 CROSSWAYS PARK WEST WOODBURY NY 11797 1 1 1 0 Chairman and CEO Common Stock, $.001 par value 2004-10-01 4 G 0 3500 0 D 12100 I Spouse Rights 8.50 2004-10-01 4 D 0 350 0 D 2001-10-05 2005-06-30 Common Stock 350 0 I Spouse Rights 8.50 2001-12-13 4 A 0 1190 0 A 2001-12-13 2005-06-30 Common Stock 1190 1190 I Spouse These shares are owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these shares. These rights attach to the shares owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these rights and the shares underlying them. Upon a transfer of shares to which the rights attach the rights are no longer exercisable. /s/ Frank Mandelbaum 2004-10-01 -----END PRIVACY-ENHANCED MESSAGE-----