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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
ANNUAL 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(h) 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).
| | Form 3 Holdings Reported
|_| Form 4 Transactions Reported
________________________________________________________________________________
1. Name and Address of Reporting Person*
Embry Russell T.
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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
________________________________________________________________________________
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
________________________________________________________________________________
4. Statement for Month/Year
February 2003
________________________________________________________________________________
5. If Amendment, Date of Original (Month/Year)
________________________________________________________________________________
page 1
FORM 5 (continued)
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| | Director |_| 10% Owner
|X| Officer (give title below) |_| Other (specify below)
Title: Senior Vice President & Chief Technology Officer
________________________________________________________________________________
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) Beneficially Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Owned Direct Nature of
Trans- Execution Code ------------------------------ at the End (D) or Indirect
1. action Date, if (Instr. 8) (A) of Issuer's Indirect Beneficial
Title of Security Date any or Fiscal Year (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price (Instr. 3 & 4) (Instr.4) (Instr.4)
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* If the form is filed by more than one reporting person, see instruction
4(b)(v).
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 control number.
Page 2
FORM 5 (continued)
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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
2. of of
Conver- 5. 7. Deriv- Deriv- 11.
sion Number of Title and Amount ative ative Nature
or Derivative 6. of Underlying 8. Secur- Secur- of
Exer- 3A. 4. Securities Date Securities Price ities ity: In-
cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Bene- Direct direct
Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ficially (D) or Bene-
1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Owned In- ficial
Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- at End direct Owner-
Derivative ative Date any 8) 4 and 5) Date Expira- Number ity of Year (I) ship
Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity yy) yy) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Stock Option
(right Common
to buy) $3.82 10/31/02 A4 6,250 10/31/02 10/31/07 Stock 6,250 D
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Stock Option
(right Common
to buy) $3.82 10/31/02 A4 6,250 04/30/03 04/30/08 Stock 6,250 D
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Stock Option
(right Common
to buy) $7.50 07/15/99 A 10,000 07/15/00 07/15/05 Stock 10,000 D
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Stock Option
(right Common
to buy) $7.50 07/15/99 A 2,500 12/01/99 12/01/04 Stock 2,500 D
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Stock Option
(right Common
to buy) $7.50 07/15/99 A 2,500 07/03/00 07/03/05 Stock 2,500 D
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Stock Option
(right Common
to buy) $7.50 07/15/99 A 5,000 06/18/01 06/18/06 Stock 5,000 D
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Stock Option
(right Common
to buy) $11.625 12/13/99 A 10,000 12/13/99 12/13/04 Stock 10,000 D
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Stock Option
(right Common
to buy) $11.625 12/13/99 A 10,000 12/13/00 12/13/05 Stock 10,000 D
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Stock Option
(right Common
to buy) $8.75 07/11/00 A 12,500 07/11/00 07/11/05 Stock 12,500 D
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Stock Option
(right Common
to buy) $8.75 07/11/00 A 12,500 01/11/01 01/11/06 Stock 12,500 77,500 D
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Explanation of Responses:
/s/ Russell T. Embry February 14, 2003
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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. 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 currently
valid OMB control number.
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