SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
TICE CHARLES L

(Last) (First) (Middle)
C/O LAKELAND BANCORP, INC.
250 OAK RIDGE ROAD

(Street)
OAK RIDGE NJ 07438

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LAKELAND BANCORP INC [ LBAI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
02/18/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 02/18/2004 M 2,000 A $7.7169 26,004(1) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Director Stock Option (right to purchase) $7.7169 02/18/2004 M 2,000 (2) 02/08/2010 Common Stock 2,000 $0 25,493 D
Explanation of Responses:
1. D: includes 108 shares acquired in 2001, 408 shares acquired in 2002 and 544 shares acquired in 2003 upon reinvestment of dividends under the Company's Dividend Reinvestment Plan. Also reflects 988 shares acquired in 2001, 1058 shares in 2002 and 1135 shares acuired in 2003 as part of 5% st0ck dividends paid by the Company in these respective years. I: 14, 476 shares held by Charles L. Tice and Mark Cummins, co trustees of Gale Tice, FBO Charles L. Tice includes 151 shares acquired in 2002 and 334 shares acquired in 2003 upon the reinvestment of dividends under the Companys Dividend Reinvestment Plan. Also reflects 309 shares acquired in 2001, 635 shares acquired in 2002 and 685 shares acquired in 2003 as part of 5% stock dividends paid by the Company in these respective years.
2. Stock Option was granted pursuint tp the Company's Equity Compensation Program and vests in 20% annual installments beginning the grant date of February 9, 2000.
Remarks:
Charles L.Tice 02/19/2004
** Signature of Reporting Person Date
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).
** 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 is insufficient, see Instruction 6 for procedure.
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 Number.