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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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
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1. Name and Address of Reporting Person*
See Exhibit A
Schreiber Warren
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(Last) (First) (Middle)
64 Shelter Lane
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(Street)
Roslyn NY 11577
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
March 26, 1999
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Conolog Corp. ("CNLG")
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [X] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing (Check applicable line)
[_] Form Filed by One Reporting Person
[X] Form Filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4)
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<S> <C> <C> <C>
Common Stock 1,057,143 I (1)
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Over)
(Form 3-07/98)
<PAGE>
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned (e.g., puts,
calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Option to Acquire
Convertible Debenture 03/26/99 10/26/99 Common Stock 1,800,000 $1.00 I (2)
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Convertible Debenture 03/26/99 - Common Stock 200,000 $1.00 I (2)
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</TABLE>
Explanation of Responses:
(1) See Rider A attached hereto.
(2) See Rider A attached hereto.
/s/Warren Schreiber April 2, 1999
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Warren Schreiber Date
The Nybor Group, Inc.
/s/Warren Schreiber April 2, 1999
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Warren Schreiber, President Date
Clog, LLC
/s/Warren Schreiber April 2, 1999
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Warren Schreiber, Member Date
/s/Robyn Schreiber April 2, 1999
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Robyn Schreiber 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.
Page 2
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Warren Schreiber
Form 3
Exhibit A
1) Name and Address of Reporting Person:
a) Clog LLC
64 Shelter Lane
Roslyn, NY 11577
b) The Nybor Group, Inc.
64 Shelter Lane
Roslyn, NY 11577
c) Robyn Schreiber
64 Shelter Lane
Roslyn, NY 11577
<PAGE>
WARREN SCHREIBER
FORM 3
RIDER A
(1) Represents shares held by the The Nybor Group, Inc., a New York corporation
("Nybor"), granted to Nybor pursuant to a consulting agreement executed
between Nybor and the Issuer on March 26, 1999, dated as of December 22,
1998. Robyn Schreiber, the wife of Warren Schreiber, is the majority and
controlling shareholder of Nybor. Warren Schreiber is the President of
Nybor.
(2) On March 26, 1999, Clog, LLC, a New York limited liability company
("Clog"), and the Issuer entered into an option agreement, dated as of
December 22, 1998, under which Clog was granted the irrevocable option and
right to immediately purchase up to $2,000,000 of convertible debentures of
the Issuer. The convertible debentures mature one year after the date of
issuance. The principal amount of the convertible debentures is immediately
convertible into shares of the Common Stock of the Issuer ("Common Shares")
at a conversion price of $1.00 per share (or an aggregate of 2,000,000
Common Shares). On March 26, 1999, Clog exercised its option to the extent
of purchasing $200,000 principal amount of convertible debentures. Warren
Schreiber is the controlling member of Clog.
