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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who 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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FREDERICKS MARK J C/O LAKELAND BANK 250 OAK RIDGE ROAD OAK RIDGE, NJ 07438 |
X |
Mark J. Fredericks | 10/19/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | D:Self includes 4,266 shares acquired as part of a 5% stock dividend paid 8/16/2005 and 1,590 shares acquired as part of the Company's Dividend Reinvestment Plan; I: 32,833 shares held by spouse, which includes 1,554 shares acquired as part of a 5% stock dividend paid 8/16/2005 and 579 shares acquired as part of the Company's DRP. I; 25,524 shares includes 1,208 shares were acquired as part of the 5% stock dividend and 451 shares recieved as part of DRP held by Keil Oil Profit Sharing Plan of which Mr. Fredericks is Trustee. I:49.330 shares held by Fredericks Fuel PSP of which Mr. Fredericks is a Trustee of this total 2,349 shares were acquired as part of the Conpany's 5% stock dividend. I: 18,427 shares held by Fredericks Fuel & Heating Service of which Mr. Fredericks is Pres. of this total 877 shares were acquired as part of the Company's 5% stock dividend. |
(2) | Includes 5,182 shares acquired as part of Company's 5% stock dividend and 1,912 shares as part of the Company's Dividend Reinvestment Plan. |