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| FORM 5 | U.S. SECURITIES AND EXCHANGE COMMISSION
+--------+ Washington, D.C. 20549
[_] Check box if
no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
to Section 16.
Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities
obligations may Exchange Act of 1934, Section 17(a) of the
continue. See Public Utility Holding Company Act of 1935 or
Instruction 1(b). Section 30(1) of the Investment Company Act of 1940
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
Lubertazzi Paul
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(Last) (First) (Middle)
c/o Lakeland Bancorp, Inc.
250 Oak Ridge Road
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(Street)
Oak Ridge New Jersey 07438
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Lakeland Bancorp, Inc.
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3. IRS or Social Security Number of Reporting Person (Voluntary)
144-26-5307
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4. Statement for Month/Year
12/31/00
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5. If Amendment, Date of Original (Month/Year)
Dec-99
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6. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [_] 10% Owner
[_] Officer [_] Other
(Title Below) (Specify Below)
0.34%
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Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) action action or Disposed of (D) Securities ship of In-
Date Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Month/ (Instr. 8) Owned at Direct Bene-
Day/ End of (D) or ficial
Lakeland Bancorp, Inc. Year) Issuer's Indirect Owner-
------------------- -------- Fiscal Year (I) ship
Amount (A) or (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4)
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Common 11/15/00 S/D 145 A $10.5360 3051 D *1
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11/15/00 S/D 1966 A $10.5360 41292 I *2
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11/15/00 S/D 12 A $10.5360 262 I *3
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11/15/00 S/D 12 A $10.5360 262 I *4
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11/15/00 S/D 12 A $10.5360 262 I *5
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11/15/00 S/D 12 A $10.5360 262 I *6
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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FORM 5 (continued)
Table II-Derivative Securities Acquired, Disposed of, or
Beneficially Owned (e.g., puts, calls, warrants, options,
convertible securities)
P. Lubertazzi
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1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv-
Security (Instr. 3) sion or action tion Code ative Securities
Exercise Date (Instr. 8) Acquired (A) or
Price of (Month/ Disposed of (D)
Deriv- Day/ (Instr. 3, 4, and 5)
ative Year)
Security
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(A) (D)
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Stock Option
Right to Purchase 9.38 2/9/00 A 25,000 --
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* Stock Option was granted pursuant to Company's 2000 Equity Compensation Program and vests in 20% annual installments
beginning on the grant date
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6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Nature
cisable and Underlying Securities of of Deriv- ship of In-
Expiration (Instr. 3 and 4) Deriv- ative of De- direct
Date ative Secur- rivative Bene-
(Month/Day/ Secur- ities Secu- ficial
Year) ity Bene- rity: Owner-
(Instr. 5) ficially Direct ship
-------------------------------------------- Owned (D) or (Instr. 4)
Date Expira- Amount or at End Indi-
Exer- tion Title Number of of Year rect (1)
cisable Date Shares (Inst. 4) (Instr. 4)
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* 2/8/10 Common 25,000 --- 25,000 D ---
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* Stock Option was granted pursuant to Company's 2000 Equity Compensation Program and vests in 20% annual installments
beginning on the grant date
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Explanation of Responses:
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*1 - Solely owned by Paul Lubertazzi
*2 - Owned by Paul & Barbara Lubertazzi, wife of Paul Lubertazzi
*3 - Paul Lubertazzi, custodian for Leslie, daughter of Paul
*4 - Paul Lubertazzi, custodian for Sandra, daughter of Paul
*5 - Paul Lubertazzi, custodian for Glen, son of Paul
*6 - Paul Lubertazzi, custodian for Mathew, son of Paul
CODES: S/D - Stock Dividend
/s/ Paul Lubertazzi June 15, 2001
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**Signature of Reporting Person Date
**Intentional misstatements or omissions of facts constitute Federal
Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 7811(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.