OMB APPROVAL
OMB NUMBER 3235-0287
EXPIRES: JANUARY 31, 2005
ESTIMATED AVERAGE BURDEN
HOURS PER RESPONSE 0.5
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 4
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
[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person
Ciongoli Bernard M.
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(Last) (First) (Middle)
955 Belmont Avenue
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(Street)
North Haledon New Jersey 07508
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Tech Laboratories, Inc. (TCHL)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Day/Year
1/30/03
2/1/03
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5. If Amendment, Date of Original (Month/Day/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
2A. 3. Disposed of (D) Beneficially Form: 7.
2. Deemed Transaction (Instr. 3, 4 and 5) Owned Follow- Direct Nature of
Trans- Execution Code ------------------------------- ing Reported (D) or Indirect
1. action Date, (Instr. 8) (A) Transaction(s) Indirect Beneficial
Title of Security Date if any ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) and 4) (Instr.4)(Instr. 4)
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Common Stock
Par Value $.01 520,000
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FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9. 10.
Number Owner-
of ship
Deriv- Form
2. ative of
Conver- 5. 7. Secur- Deriv- 11.
sion Number of Title and Amount ities ative Nature
or 3A. Derivative 6. of Underlying 8. Bene- Secur- of
Exer- Deemed 4. Securities Date Securities Price ficially ity: In-
cise 3. Exe- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Owned Direct direct
Price Trans- cution action or Disposed Expiration Date ---------------- Deriv- Following (D) or Bene-
1. of action Date, Code of(D) (Month/Day/Year) Amount ative Reported In- ficial
Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner-
Derivative ative (Month/ Month/ 8) 4 and 5) Date Expira- Number ity action (I) ship
Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr.(Instr.
(Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Employment $.50 Presently 10/1/03 Common 100,000 100,000 D
Agreement Stock
Option
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Employment $.50 Presently 10/1/03 Common 100,000 100,000 D
Agreement Stock
Option
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Employment $.50 Presently 10/1/03 Common 100,000 100,000 D
Agreement Stock
Option
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1996 $.9625 Presently 3/1/06 Common 100,000 100,000 D
Incentive Stock
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Stock Option $2.68125 1/30/03 A 37,000 Presently 1/2/06 Common 37,000 111,000 D
Stock
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Stock Option $2.4375 Presently 4/24/06 Common 92,666 92,666 D
Stock
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Employment $.43 2/1/03 A 100,000 Presently 8/1/06 Common 100,000 300,000 D
Agreement Stock
Option
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Explanation of Responses:
/S/ Bernard M. Ciongoli April 17, 2003
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**Signature of Reporting Person Date
This statement is being filed pursuant to the vesting of previously granted
stock options. No new options have been granted to Mr. Ciongoli.
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 provided is insufficient, see Instruction 6 for procedure.
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