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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).