U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL 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).
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
PALM CHARLES S.
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(Last) (First) (Middle)
31324 VIA COLINAS, #106
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(Street)
WESTLAKE VILLAGE CA 91362
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
SYNTHONICS TECHNOLOGIES, INC. (SNNT)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
DECEMBER 1999
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
CHIEF TECHNOLOGY OFFICER
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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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<TABLE>
<CAPTION>
5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
COMMON STOCK, $0.01 PAR VALUE 428,751 D
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</TABLE>
* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses) (Over)
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
OPTION TO $0.50 7/1/96 A 600,000 7/1/99 7/1/06 COMMON 600,000 600,000 D
PURCHASE STOCK
SHARES OF ----------------------------------------------------------------------------------------------------------------
COMMON $0.50 7/1/96 A 150,000 7/1/00 7/1/06 COMMON 150,000 150,000 D
STOCK STOCK
$0.01 PAR ----------------------------------------------------------------------------------------------------------------
VALUE OF $1.00 12/31/96 A 412,260 12/31/96 12/31/01 COMMON 412,260 412,260 D
SYNTHONICS STOCK
TECHNOLOGIES, ----------------------------------------------------------------------------------------------------------------
INC. $1.00 12/31/97 A 189,430 12/31/97 12/31/02 COMMON 189,430 189,430 D
STOCK
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$0.53 12/31/98 A 385,142 12/31/98 12/31/03 COMMON 385,142 385,142 D
STOCK
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$0.20 4/30/99 A 232,586 4/30/99 4/30/04 COMMON 232,586 232,586 D
STOCK
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$0.13 6/30/99 A 153,403 6/30/99 6/30/04 COMMON 153,403 153,403 D
STOCK
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$0.07 9/30/99 A 72,360 9/30/99 9/30/04 COMMON 72,360 72,360 D
STOCK
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$0.10 10/1/99 A 1,125,000 10/1/99 9/30/03 COMMON 1,125,000 1,125,000 D
STOCK
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</TABLE>
Explanation of Responses:
The above is correct as of 12/31/99.
/S/ CHARLES S. PALM February 9, 2000
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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. 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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