-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, M5ESnl4IfF854frsAxDCmtUfiQgUhC/ggvBORnKZ++oedkY7NXlL4tMXdAqPceVf CpxHyBfHtzMvzuRKNqEBiQ== 0001021771-04-000049.txt : 20040217 0001021771-04-000049.hdr.sgml : 20040216 20040217164112 ACCESSION NUMBER: 0001021771-04-000049 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040217 GROUP MEMBERS: MORTON L. CERTILMAN SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: DCAP GROUP INC/ CENTRAL INDEX KEY: 0000033992 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 362476480 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-12743 FILM NUMBER: 04609432 BUSINESS ADDRESS: STREET 1: 90 MERRICK AVE STREET 2: 9TH FLOOR CITY: EAST MEADOW STATE: NY ZIP: 11554 BUSINESS PHONE: 5167946300 MAIL ADDRESS: STREET 1: 90 MERRICK AVE 9TH FLOOR STREET 2: 90 MERRICK AVE 9TH FLOOR CITY: EAST MEADOW STATE: NY ZIP: 11554 FORMER COMPANY: FORMER CONFORMED NAME: EXTECH CORP DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: EXECUTIVE HOUSE INC DATE OF NAME CHANGE: 19911119 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: CERTILMAN MORTON L CENTRAL INDEX KEY: 0001016869 STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A BUSINESS ADDRESS: STREET 1: 90 MERRICK AVE STREET 2: 9TH FLOOR CITY: EAST MEADOW STATE: NY ZIP: 11554 BUSINESS PHONE: 5167946300 MAIL ADDRESS: STREET 1: 90 MERRICK AVE 9TH FLOOR STREET 2: 90 MERRICK AVE 9TH FLOOR CITY: EAST MEADOW STATE: NY ZIP: 11554 FORMER COMPANY: FORMER CONFORMED NAME: DCAP GROUP INC DATE OF NAME CHANGE: 19990305 FORMER COMPANY: FORMER CONFORMED NAME: CERTILMAN MORTON L DATE OF NAME CHANGE: 19960614 SC 13D/A 1 amendment2.txt SCHEDULE 13D/A2 MORTON L. CERTILMAN 12/2/03 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 SCHEDULE 13D (Rule 13d-101) INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULE 13d-1(a) AND AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2(a) (Amendment No. 2 )* --- DCAP Group, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, $.01 Par Value - -------------------------------------------------------------------------------- (Title of Class of Securities) 233065 10 1 - -------------------------------------------------------------------------------- (CUSIP Number) Morton L. Certilman 90 Merrick Avenue East Meadow, New York 11554 (516) 296-7000 (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) December 2, 2003 - -------------------------------------------------------------------------------- (Date of Event Which Requires Filing of This Statement) If the Filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d-1 (b)(3) or (4), check the following box [ ] *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). Page 1 of 5 Pages SCHEDULE 13D CUSIP No. 233065 10 1 1. Name of Reporting Person Morton L. Certilman 2. Check the appropriate box if a member of a group (a) [ ] (b) [ ] 3. SEC Use Only 4. Source of Funds N/A 5. Check box if disclosure of legal proceedings is required pursuant to items 2(d) or 2(e)[ ] 6. Citizenship or Place of Organization United States Number of Shares 7. Sole Voting Power Beneficially Owned 1,281,005 By Each Reporting ---------------------------------------------- Person With 8. Shared Voting Power 0 ---------------------------------------------- 9. Sole Dispositive Power 1,281,005 ---------------------------------------------- 10. Shared Dispositive Power 0 11. Aggregate Amount Beneficially Owned by Reporting Person 1,281,005 12. Check Box if the Aggregate Amount in Row (11) Excludes Certain Shares [ ] 13. Percent of Class Represented by Amount in Row (11) 10.1% 14. Type of Reporting Person IN ITEM 1. SECURITY AND ISSUER. ------------------- This statement amends and supplements the Schedule 13D for an event dated March 28, 2001, as previously amended by Amendment No. 1, for an event dated May 17, 2002, filed by the Reporting Person relating to shares of Common Stock, par value $.01 per share (the "Common Stock"), of DCAP Group, Inc., a Delaware corporation (the "Company"). The address of the principal executive offices of the Company is 1158 Broadway, Hewlett, New York 11557. ITEM 2. IDENTITY AND BACKGROUND. ----------------------- (a) Name of Reporting Person: Morton L. Certilman (b) Residence or business address: 90 Merrick Avenue East Meadow, New York 11554 (c) The Reporting Person is engaged in the practice of law. (d) The Reporting Person has not been convicted in a criminal proceeding in the last five years. (e) The Reporting Person has not, during the last five years, been a party to a civil proceeding of a judicial or administrative body of competent jurisdiction resulting in a judgment, decree or final order enjoining future violations of, or prohibiting or mandating activities subject to, federal or state securities laws or finding any violation with respect to such laws. (f) The Reporting Person is a citizen of the United States of America. ITEM 3. SOURCE AND AMOUNT OF FUNDS OR OTHER CONSIDERATION. ------------------------------------------------- Not Applicable ITEM 4. PURPOSE OF TRANSACTION. ---------------------- Not Applicable. ITEM 5. INTEREST IN SECURITIES OF THE ISSUER. ------------------------------------ As of the date hereof, the Reporting Person is the beneficial owner of 1,281,005 shares of Common Stock of the Company (or approximately 10.1% of the outstanding Common Stock of the Company). Of such shares of Common Stock, 350,000 are issuable upon the exercise of options that are currently exercisable. The Reporting Person has sole voting and dispositive power over all of such shares. During the past 60 days, the Reporting Person has not effected any transactions in the Common Stock of the Company, except that the Report Person gifted an aggregate of 120,000 shares. ITEM 6. CONTRACTS, AGREEMENTS, UNDERSTANDINGS OR RELATIONSHIPS WITH RESPECT TO SECURITIES OF THE ISSUER. ----------------------------------- Not applicable. ITEM 7. MATERIAL TO BE FILED AS EXHIBITS. -------------------------------- Not applicable. SIGNATURES After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Dated: February 17, 2004 -- /s/ Morton L. Certilman ------------------------ Morton L. Certilman -----END PRIVACY-ENHANCED MESSAGE-----