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).
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1. Name and Address of Reporting Person*
Mandelbaum Frank
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(Last) (First) (Middle)
246 Crossways Park West
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(Street)
Woodbury New York 11797
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Intelli-Check, Inc. (IDN)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December 16, 2002
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
Title if applicable: Chairman & Chief Executive Officer
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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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)
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Common Stock, $.01 par value 12/16/02 G V 3,000 D
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525,300 D
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24,900 I**
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*These sales were made by Prudential Securities Incorporated as Pledgee of Mr. Mandelbaum's shares.
**These shares are owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these shares.
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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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)
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Rights+ 12/16/02 D V 300
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Option Common
(Right to Buy) $12.10 02/01/02 A 350,000 ** 02/01/07 Stock 350,000
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Common
Rights* $8.50 12/13/01 A 2,490 Current 04/04/03 Stock 2,490
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Option Common
(Right to Buy) $3.00 A 25,000 01/01/02 01/01/05 Stock 25,000
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Rights $8.50 12/13/01 A 58,000 Current 04/04/03 Common 58,000
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Common
Rights $8.50 10/05/01 A 44,100++ Current 04/04/03 Stock 44,100++
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Option Common
(Right to Buy) $3.00 A 25,000 01/01/01 01/01/05 Stock 25,000
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Option Common
(Right to Buy) $3.00 A 25,000 01/01/00 01/01/05 Stock 25,000
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Option Common
(Right to Buy) $3.00 A 50,000 Current 09/04/03 Stock 50,000
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Option Common
(Right to Buy) $3.00 A 375,000 Current 07/15/04 Stock 375,000
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2,490* I
952,100 D
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Explanation of Responses:
* These rights attach 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 are no longer
exercisable.
** Of these options, 125,000 which were granted pursuant to the Issuer's 2001
Stock Option Plan are immediately exercisable. Of the remaining 225,000
options, which are non-plan options, an additional 75,000 options will
become exercisable on December 31 of each of the 2002, 2003 and 2004.
*** 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/ Frank Mandelbaum Jan. 2, 2003
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***Signature of Reporting Person Date
Frank Mandelbaum
+The disposal of these rights was due to sales of shares by prudential
Securities Incorporated as Pledgee of Mr. Mandelbaum's shares.
++ The deduction of 200 Rights due to sales on September 17 and September 18
were inadvertently omitted.
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.