SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
WALLACH ANDREW W

(Last) (First) (Middle)
1114 AVENUE OF THE AMERICAS

(Street)
NEW YORK NY 10036

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/01/2003
3. Issuer Name and Ticker or Trading Symbol
MILESTONE SCIENTIFIC INC/NJ [ MS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, par value $.001 per share 1,798,467 I See footnote(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants 01/31/2000 01/31/2005 Common Stock 28,572 (2) I See footnote(1)
Explanation of Responses:
1. The reporting person is a member of Cumberland Associates LLC, a limited liability company organized under the laws of the State of New York which is engaged in the business of managing, on a discretionary basis, various securities accounts. Cumberland Associates purchased these Securities on behalf of one or more of these accounts (the "Accounts"), and the reporting person disclaims beneficial ownership of these Securities except to the extent of his share in Cumberland Associates' indirect pecuniary interest therein, which pecuniary interest, if any, is limited to incentive fees and/or allocations payable to Cumberland Associates based on a percentage of realized and/or unrealized gains with respect to these Securities held in the Accounts.
2. The Warrants are exercisable for Common Stock at a variable exercise price equal to $1.75 per share until December 31, 2000; then $2.50 per share until December 31, 2001; then $5.00 per share until December 31, 2002; then $6.00 per share until December 31, 2003; then $7.00 per share until January 31, 2005.
/s/ Andrew M. Wallach 10/08/2003
** 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 5 (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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