-----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, MgpqNcaXzROBmtQbyyTgyGPhRS49gwA3Pq78m69AduSG4yaOTSejPNbbAsjrifeZ fKJcluBTLXuzzAEYJUli0A== 0000752294-03-000001.txt : 20030204 0000752294-03-000001.hdr.sgml : 20030204 20030204113952 ACCESSION NUMBER: 0000752294-03-000001 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030204 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ELECTRONIC SYSTEMS TECHNOLOGY INC CENTRAL INDEX KEY: 0000752294 STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS & ACCESSORIES [3670] IRS NUMBER: 911238077 STATE OF INCORPORATION: WA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27793 FILM NUMBER: 03537742 BUSINESS ADDRESS: STREET 1: 415 N QUAY STREET CITY: KENNEWICK STATE: WA ZIP: 99336 BUSINESS PHONE: 5097359092 MAIL ADDRESS: STREET 1: 415 N QUAY #4 CITY: KENNEWICK STATE: WA ZIP: 99336 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: ELECTRONIC SYSTEMS TECHNOLOGY INC CENTRAL INDEX KEY: 0000752294 STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS & ACCESSORIES [3670] RELATIONSHIP: OFFICER IRS NUMBER: 911238077 STATE OF INCORPORATION: WA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 415 N QUAY STREET CITY: KENNEWICK STATE: WA ZIP: 99336 BUSINESS PHONE: 5097359092 MAIL ADDRESS: STREET 1: 415 N QUAY #4 CITY: KENNEWICK STATE: WA ZIP: 99336 5 1 form5tk.htm FORM 5 FORM 5

FORM 5

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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(f) of the Investment Company Act of 1940.

  1. Name and Address of Reporting Person*

Kirchner Tom L

 2. Issuer Name and Ticker or Trading Symbol

Electronic Systems Technology Inc
ELST		 Relationship of Reporting Person to Issuer
(Check all Applicable)

__X___ Director _______ 10% Owner
_  X  __ Officer (give title)
______ Other (Specify below)

President/CEO
(Last) (First) (Middle)

354 W. Adair Dr.

 3. IRS Identification Number of Reporting Person at an entity
(Voluntary)		 4. Statement for (Month/Year)

12/2002

(Street)

Richland WA 99352

 5. If Amendment; Date of Original (Month/Year) 7. Individual or Joint/Group Reporting
(check applicable line)

_X__Form Filed by One Reporting Person
____Form Filed by more than One Reporting Person
(City) (State) (Zip) Table 1 – Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security
(Instr. 3)		 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Dated, 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 at end of Issuers Fiscal Year
(Instr. 3 & 4)		 6. Ownership Form Direct  (D) or Indirect (I)    (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)

Amount

 (A)
or
(D)		 Price
COMMON             403,488 D  
                   
                   
                   
                   
                   

*If the form is filed by more that one Reporting Person see Instruction 4(b)(v).

 

 

FORM 5
(Continued)

Table II – Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative Security 2.Conversion or Exercise Price of Derivative Security 3.Transaction Date (Month/
Day/Year)		 3A.Deemed Execution Dated, If any (Month/
Day/Year)		 4.Transaction Code
(Instr. 8)		 5. Number of Derivative Securities Acquired (A) or Disposed (D)   (Instr. 3,4 & 5) 6. Date Exercisable and Expiration Date     (Month/Day/Year) 7. Title and Amount of Underlying Securities           (Instr. 3 & 4)

8. Price of Derivative security (Instr. 5)

 9. Number of Derivative Securities Beneficially Owned at End of Year    (Instr. 4) 10.Ownership of Derivative Security: Direct (D) or Indirect (I)     (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Date Exercisable Expiration Date Title Amount of Number of Shares
(A) (D)
OPTIONS             2/11/00 2/11/03 Common 25,000 $2.81 25,000 D  
OPTIONS             2/9/01 2/9/04 Common 25,000 $0.44 25,000 D  
OPTIONS             2/15/02 2/14/05 Common 25,000 $0.42 25,000 D  
                             
                             
                             
                             
                             
                             
                             
                             

Explanation of Responses:

 

 

**Intentional misstatements or omissions of facts constitute Federal Criminal Violations.

See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a)

/s/ TOM L KIRCHNER Feb 3, 2003
__________________________________ ___________
** Signature of Reporting Person Date

 

 

 

 

 

 

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