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DSS, INC. — Director's Dealing 2004
Oct 5, 2004
35136_dirs_2004-10-05_22351dce-8975-422b-aedf-372372b5d23c.zip
Director's Dealing
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SEC Form 3 — Initial Statement of Beneficial Ownership
Issuer: DOCUMENT SECURITY SYSTEMS INC (DSS)
CIK: 0000771999
Period of Report: 2004-09-24
Reporting Person: FAGENSON ROBERT B (Director)
Holdings (Non-Derivative)
| Security | Shares | Ownership |
|---|---|---|
| Common Stock | 800000 | Direct |
| Common Stock | 100000 | Indirect |
| Common Stock | 50000 | Indirect |
| Common Stock | 50000 | Indirect |
Holdings (Derivative)
| Security | Exercise Price | Expiration | Underlying | Shares | Ownership |
|---|---|---|---|---|---|
| Options | $6.00 | 2004-09-24 | Common Stock (2500) | Direct |
Footnotes
F1: Reflects the potential grant of 2,500 options to purchase shares of Common Stock pursuant to the Company's
Non-Employee Director Option Plan which was approved by the Board of Directors but has not been approved
as of the date of this filing by shareholders. The date of grant, assuming shareholder approval, will be the date
that Reporting Person joined the Board of Directors (September 24, 2004).
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