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*
BUTLEIN ERIC

(Last) (First) (Middle)
9303 N. Valley Road

(Street)
Milwaukee WI 53217

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CASH TECHNOLOGIES INC [ TQ ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/11/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 09/11/2003 J(1)(2)(3) 98,872 A $0(1)(2)(3) 98,872 I By Ada Partners, LLC
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
1. Name and Address of Reporting Person*
BUTLEIN ERIC

(Last) (First) (Middle)
9303 N. Valley Road

(Street)
Milwaukee WI 53217

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
BUTLEIN JAYNE

(Last) (First) (Middle)
9303 N. Valley Hill Rd.

(Street)
Milwaukee WI 53217

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
EJADA L P

(Last) (First) (Middle)
9303 N. VALLEY HILL RD.

(Street)
MILWAUKEE WI 53217

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. Reporting person was issued shares of Common Stock as payment of accrued dividends on an aggregate of 480,769 shares of Series C Preferred Stock.
2. Additional shares of Common Stock are beneficially owned by Reporting Person, held in the following names: (a) 659,098 shares held in the name of Ejada Limited Partnership, of which Reporting Person in General Partner; (b) 20,000 shares held in the name of Eric & Jayne Butlein 1994 Revocable Trust, of which Reporting Person is Trustee; (c) 315,000 shares held in the name of Tikkun Olam Foundation, Inc., of which Reporting Person is President; (d) 10,000 shares held in the name of EADA Grantor Retained Annuity Trust, of which Reporting Person is Trustee; and (e) 5,200 shares held in the name of JADA Grantor Retained Annuity Trust, of which Reporting Person is Trustee.
3. Ms. Jayne Butlein, an additional reproting person also serves as a general partner of Ejada, Limited Partnership and as a Trustee of the Eric & Jayne Butlein 1994 Revocable Trust, JADA Grantor Retained Annuity Trust and EADA Grantor Retained Annuity Trust.
Remarks:
The Reporting Persons for the purposes of this Form 4 are Mr. Eric Butlein, Ms. Jayne Butlein and Ejada Limited Partnership, who consist of a "group" for purposes of Section 13(d) of the Exchange Act of 1934, as amended. The information set forth in Items 1, 2 and 4 of this Form 4 are applicable to each of the Reporting Persons.
Eric Butlein 11/13/2003
Jayne Butlein 11/13/2003
Ejada Limited Partnership 11/13/2003
** 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.
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