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| FORM 5 | U.S. SECURITIES AND EXCHANGE COMMISSION
+--------+ Washington, D.C. 20551
[_] 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(l) of the Investment Company Act of 1942
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
Pier, Jr. John J
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(Last) (First) (Middle)
c/o Lakeland Bancorp, Inc. 250 Oak Ridge Road
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(Street)
Oak Ridge NJ 07438
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(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol Lakeland Bancorp, Inc. -- LBAI
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3. IRS or Social Security Number of Reporting Person (Voluntary) 146-16-7006
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4. Statement for Month/Year December - 2000
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5. If Amendment, Date of Original Month/Year December - 1999
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6. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [ ] Officer [ ] 10% Owner [X] Other
(give title below) (specify below)
0.72%
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Table 1 -- 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. Ownership 7. Nature
(Instr. 3) action action or Disposed of (D) Securities Form: of Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial
Lakeland Bancorp, Inc. (MM/ (Instr. 8) Owned at (D) or Ownership
DD/ End of Indirect (Instr. 4)
YY) Issuer's (I)
(A) or Fiscal Year (Instr. 4)
Amount (D) Price (Instr. 3 and 4)
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Common 02/15/00 DRP 380 A $12.5000 D *1
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Common 09/20/00 T 36,707 D D *1
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Common 11/15/00 S/D 1,350 A D *1
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Common 11/15/00 S/D 21 A 28,810 D *1
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11/15/00 S/D 626 A 13,346 D *2
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09/20/00 T 36,707 A I *3
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02/15/00 DRP 28 A $12.5000 I *3
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11/15/00 S/D 2,066 A 43,400 I *3
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02/15/00 DRP 57 A 10,139 I *4
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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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 (mm/ Disposed of (D)
Deriv- dd/ (Instr. 3, 4, and 5)
ative yy)
Security
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(A) (D)
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Stock Option Right to
Purchase $ 9.380 02/09/00 A 25,000
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* Stock Option was granted pursuant to Company's 2000 Equity Compensation program and vests in 20% annual installments
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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
(mm/dd/ Secur- ities Secu- Bene-
yy) 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 25,000 D --
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Explanation of Responses:
*1 Solely owned by John Pier
*2 Owned by John Pier in IRA
*3 Solely owned by Jane Pier, spouse of John Pier
*4 Owned by John Pier and Jane Pier, spouse of John Pier
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CODES
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DRP Dividend Reinvestment Plan
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S/D Stock Dividend
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S/O Stock Option
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T Transfer
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VP Voluntary Purchase
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P Purchase
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PM Purchase Market
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/s/ John Pier 2/2/01
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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