0001493152-21-024456.txt : 20211004 0001493152-21-024456.hdr.sgml : 20211004 20211004125134 ACCESSION NUMBER: 0001493152-21-024456 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210930 FILED AS OF DATE: 20211004 DATE AS OF CHANGE: 20211004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DAVIS JACK ALAN CENTRAL INDEX KEY: 0001356205 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15465 FILM NUMBER: 211301708 MAIL ADDRESS: STREET 1: 1520 OLD TROLLEY ROAD CITY: SUMMERVILLE STATE: SC ZIP: 29485 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Intellicheck, 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: 200 BROADHOLLOW ROAD STREET 2: SUITE 207 CITY: MELVILLE STATE: NY ZIP: 11747 BUSINESS PHONE: 516-992-1900 MAIL ADDRESS: STREET 1: 200 BROADHOLLOW ROAD STREET 2: SUITE 207 CITY: MELVILLE STATE: NY ZIP: 11747 FORMER COMPANY: FORMER CONFORMED NAME: Intellicheck Mobilisa, Inc. DATE OF NAME CHANGE: 20100527 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 ownership.xml X0306 4 2021-09-30 0 0001040896 Intellicheck, Inc. IDN 0001356205 DAVIS JACK ALAN 200 BROADHOLLOW ROAD, SUITE 207 MELVILLE, NY 11747 1 0 0 0 Restricted Stock Units (RSU's) 8.19 2021-09-30 4 A 0 611 0 A 2021-09-30 Common Stock 611 611 D Restricted Stock Units became earned and vested, and shares of common stock were issued in settlement of Vested Restricted Stock Units on September 30, 2021. /s/ Bill White, Attorney-In-Fact 2021-10-04