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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 New York 11577
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
June 17, 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)
June 28, 1999
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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 06/17/99 12/31/99 Common Stock 2,000,000 $1.00 I (2)
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</TABLE>
Explanation of Responses:
(1) See Rider A
(2) See Rider A
/s/ Warren Schreiber June 30, 1999
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**Signature of Reporting Person Date
Warren Schreiber
The Nybor Group, Inc.
/s/ Warren Schreiber June 30, 1999
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**Signature of Reporting Person Date
Warren Schreiber, President
CLOG, LLC
/s/ Warren Schreiber June 30, 1999
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**Signature of Reporting Person Date
Warren Schreiber, Member
/s/ Robyn Schreiber June 30, 1999
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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.
Page 2
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
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WARREN SCHREIBER
FORM 3
RIDER A
(1) Represents shares obtained by The Nybor Group, Inc., a New York corporation
("Nybor"), pursuant to an Amended and Restated Consulting Agreement entered
into between Nybor and the Issuer on May 5, 1999 ("Restated Consulting
Agreement"). The issuance of the shares was subject to shareholder approval
of the Restated Consulting Agreement, which approval was obtained on June
17, 1999. Robyn Schreiber, the wife of Warren Schreiber, is the sole
shareholder of Nybor. Warren Schreiber is the President of Nybor.
(2) On May 5, 1999, CLOG LLC, a New York limited liability company ("CLOG"),
and the Issuer entered into an Amended and Restated Option Agreement,
("Restated Option Agreement"), pursuant to which CLOG was granted the
irrevocable option and right to purchase up to $2,000,000 of convertible
debentures of the Issuer subject to shareholder approval of the Restated
Option Agreement. Such shareholder approval was obtained on June 17, 1999.
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). Warren Schreiber is the controlling member of CLOG.
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