OMB APPROVAL
OMB NUMBER 3235-0287
EXPIRES: JANUARY 31, 2005
ESTIMATED AVERAGE BURDEN
HOURS PER RESPONSE 0.5
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*
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(Last) (First) (Middle)
Cohen Todd Jay
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(Street)
PO Box 20054
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(City) (State) (Zip)
Huntington Station New York 11746
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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/Day/Year
January 17, 2003
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5. If Amendment, Date of Original (Month/Day/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [X] 10% Owner
[ ] Officer (give title below) [_] Other (specify below)
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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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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
2A. 3. Disposed of (D) Befeficially Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Owned Follow- Direct Nature of
Trans- Executin Code ------------------------------- ing Reported (D) or Indirect
1. action Date, (Instr. 8) (A) Transaction(s) Indirect Beneficial
Title of Security Date if any ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) and 4) (Instr.4)(Instr. 4)
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Common Stock, $.01
par value 01/17/03 S 3,000 D $8.00
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737,800 D
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
(Over)
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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9. 10.
Number Owner-
of ship
Deriv- Form
2. ative of
Conver- 5. 7. Secur- Deriv- 11.
sion Number of Title and Amount ities ative Nature
or 3A. Derivative 6. of Underlying 8. Bene- Secur- of
Exer- Deemed 4. Securities Date Securities Price ficially ity: In-
cise 3. Exe- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Owned Direct direct
Price Trans- cution action or Disposed Expiration Date ---------------- Deriv- Following (D) or Bene-
1. of action Date, Code of(D) (Month/Day/Year) Amount ative Reported In- ficial
Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner-
Derivative ative (Month/ Month/ 8) 4 and 5) Date Expira- Number ity action (I) ship
Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr.(Instr.
(Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Rights $8.50 01/17/03 D 300*
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Option Common
(Right to Buy) $3.00 07/15/99 A 110,000 Current 07/15/04 Stock 110,000
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Common
Rights $8.50 10/05/01 A 85,300 Current 04/04/03 Stock 85,300
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195,300 D
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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.
By: /s/ Todd Cohen Jan. 21, 2003
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***Signature of Reporting Person Date
Todd Cohen
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(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.
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 current
valid OMB Number.