0001144204-11-071071.txt : 20111221 0001144204-11-071071.hdr.sgml : 20111221 20111221174254 ACCESSION NUMBER: 0001144204-11-071071 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111221 FILED AS OF DATE: 20111221 DATE AS OF CHANGE: 20111221 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Smith Guy L CENTRAL INDEX KEY: 0001326916 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-50296 FILM NUMBER: 111275323 MAIL ADDRESS: STREET 1: 246 CROSSWAYS PARK WEST CITY: WOODBURY STATE: NY ZIP: 11797 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Intellicheck Mobilisa, 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: 191 OTTO STREET CITY: PORT TOWNSEND STATE: WA ZIP: 98368 BUSINESS PHONE: 516-992-1900 MAIL ADDRESS: STREET 1: 191 OTTO STREET CITY: PORT TOWNSEND STATE: WA ZIP: 98368 FORMER COMPANY: FORMER CONFORMED NAME: Intelli Check Mobilisa, Inc DATE OF NAME CHANGE: 20080319 FORMER COMPANY: FORMER CONFORMED NAME: INTELLI CHECK INC DATE OF NAME CHANGE: 19990917 4 1 v243745_4.xml OWNERSHIP DOCUMENT X0304 4 2011-12-21 0 0001040896 Intellicheck Mobilisa, Inc. IDN 0001326916 Smith Guy L 191 OTTO STREET PORT TOWNSEND WA 98368 1 0 0 0 Common Stock, $.001 par value 2011-12-21 4 P 0 1000 0.8588 A 59707 D Common Stock, $.001 par value 2011-12-21 4 P 0 1000 0.8748 A 60707 D Common Stock, $.001 par value 2011-12-21 4 P 0 1500 0.86 A 62207 D /s/ Peter J. Mundy, Attorney-In-Fact 2011-12-21