-----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, Ap3PrYG9kNlqFsEDz40BpG/AUQXrWOQQhxf0feHmVTcdXs2KKbmpeywl+1EV1gha SGmhnsVQVCEzJSrD/pI3Ow== 0001177651-02-000309.txt : 20021029 0001177651-02-000309.hdr.sgml : 20021029 20021029155921 ACCESSION NUMBER: 0001177651-02-000309 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021023 FILED AS OF DATE: 20021029 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 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: 02801475 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 4 1 doc1.txt 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* Cohen Todd Jay - -------------------------------------------------------------------------------- (Last) (First) (Middle) PO Box 20054 - -------------------------------------------------------------------------------- (Street) Huntington Station New York 11746 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 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/Year October 25, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [X] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) Title if applicable: ________________________________________________________________________________ 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 ================================================================================
6. 4. 5. Owner- Securities Acquired (A) Amount of ship 3. or Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------ Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, $.01 par value 10/25/02 S 1,000 D $3.25 - ----------------------------------------------------------------------------------------------------------------------------------- 784,800 D - ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
=================================================================================================================================== 10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ---------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V A D cisable Date Title Shares 5) 4) 4) 4) - ----------------------------------------------------------------------------------------------------------------------------------- Rights $8.50 10/25/02 D 100* - ----------------------------------------------------------------------------------------------------------------------------------- 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 90,000 Current 04/04/03 Stock 90,000 - ----------------------------------------------------------------------------------------------------------------------------------- 200,000 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. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). By: /s/ Todd Cohen Oct. 29, 2002 -------------------------------- --------------- ***Signature of Reporting Person Date Todd Cohen
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 currently valid OMB Number. -----END PRIVACY-ENHANCED MESSAGE-----