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| FORM 5 | U.S. SECURITIES AND EXCHANGE COMMISSION
+--------+ Washington, D.C. 20549
[_] Check box if
no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
to Section 16.
Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities
obligations may Exchange Act of 1934, Section 17(a) of the
continue. See Public Utility Holding Company Act of 1935 or
Instruction 1(b). Section 30(1) of the Investment Company Act of 1940
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
Deacon Mary Ann
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(Last) (First) (Middle)
c/o Lakeland Bancorp, Inc.
250 Oak Ridge Road
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(Street)
Oak Ridge New Jersey 07438
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(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol Lakeland Bancorp, Inc.
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3. IRS or Social Security Number of Reporting Person
(Voluntary) 146-46-8710
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4. Statement for Month/Year 12/31/00
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5. If Amendment, Date of Original (Month/Year) 07/01/00
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6. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [_] Officer [_] 10% Owner [_] Other
(Title Below) (Specify Below)
0.70%
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Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) action action or Disposed of (D) Securities ship of In-
Date Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Month/ (Instr. 8) Owned at the Direct Bene-
Lakeland Bancorp, Inc. Day/ end of (D) or ficial
Year) Issuer's Indirect Owner-
(A) or Fiscal Year (I) ship
Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4)
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Common 08/15/00 DRP 305 A $11.7140 D *1
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11/15/00 S/D 126 A D *1
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11/15/00 DRP 350 A $10.9250 D *1
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11/15/00 S/D 2265 A D *1
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12/28/00 T 50071 A 500 D *1
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12/28/00 T 50071 A 50071 D *2
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11/15/00 S/D 19 A 409 D *3
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08/15/00 DRP 248 A $11.7140 I *4
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11/15/00 S/D 54 A I *4
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11/15/00 DRP 285 A $10.9250 I *4
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11/15/00 S/D 1895 A I *4
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12/28/00 T 41203 D I *4
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12/28/00 T 41203 A 41203 I *5
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11/15/00 S/D 18 A 378 I *6
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly
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* If the form is filed by more than one reporting person, see instruction
4(b)(v).
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FORM 5 (Continued)
Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
M. Deacon
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1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv-
Security (Instr. 3) sion or action tion Code ative Securities
Exercise Date (Instr. 8) Acquired (A) or
Price of (Month/ Disposed of (D)
Deriv- Day/ (Instr. 3, 4, and 5)
ative Year)
Security
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(A) (D)
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Stock Option
Right to Purchase 9.38 2/9/00 A 25,000 ---
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* Stock Option was granted pursuant to company's 2000 Equity Compensation program and vest in 20% annual installments
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beginning on the grant date
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6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na-
cisable and Underlying Securities of of Deriv- ship ture
Expiration (Instr. 3 and 4) Deriv- ative of De- of In-
Date ative Secur- rivative direct
(Month/Day/ Secur- ities Secu- Bene-
Year) ity Bene- rity: ficial
(Instr. 5) ficially Direct Owner-
-------------------------------------------- Owned (D) or ship
Date Expira- Amount or at End Indi- (Instr. 4)
Exer- tion Title Number of of Year rect (1)
cisable Date Shares (Instr. 4) (Instr. 4)
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* 2/8/10 Common 25,000 ---- 20,000 D ----
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Explanation of Responses:
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*1 Solely owned by Mary Ann Deacon *4 Solely owned by Philip Deacon, spouse of Mary Ann Deacon
*2 Solely owned by Mary Ann Deacon - Limited Partner *5 Solely owned by Philip Deacon Limited Partnership,
*3 Solely owned by Mary Ann Deacon in IRA spouse of Mary Ann Deacon
*6 Solely owned by Philip Deacon, spouse of Mary Ann Deacon,
in IRA account
CODES:
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DRP - Dividend Reinvestment Plan
S/D - Stock Dividend
T Transfer
/s/ Mary Ann Deacon 1/24/01
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 7811(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.