U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
WASHINGTON, D.C. 20549
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FORM 3 OMB APPROVAL
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OMB Number 3235-0104
Expires: September 30, 1997
Estimated average burden
hours per response......0.5
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
(Print or Type Responses)
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1. Name and Address of Reporting Person*
Chluski John J.
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(Last) (First) (Middle)
980 North Federal Highway, Suite 206
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(Street)
Boca Raton, Florida 33432
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(City) (State) (Zip)
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2. Date of Event Requiring
Statement
(Month/Day/Year)
11/01/96
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3. IRS or Social Security
Number of Reporting
Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Lasergate Systems, Inc. - LSGT
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
X Director 10% Owner
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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. Indiviual 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>
<CAPTION>
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect
(Instr. 4) Beneficially Owned Form: Direct Beneficial Ownership
(D) or Indirect (Intr. 5)
(Instr. 4) (I) (Instr. 5)
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<S> <C> <C>
None
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Over)
* If the form is filed by more than one reporting person, see Instruction
5(b)(v).
SEC 1473 (7-96)
<PAGE>
FORM 3 (CONTINUED)
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS,
WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative Security (Instr. 4)
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2. Date Exercisable and Expiration Date (Month/Day/ Year)
Date
Exercisable Expiration Date
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3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
Amount or
Number of
Title Shares
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security:
Direct (D) or Indirect (I) (Instr. 5)
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6. Nature of Indirect Beneficial Ownership (Instr. 5)
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Explanation of Responses:
/S/ John J. Chluski January 13, 1997
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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.
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB Number.
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SEC 1473 (7-96)
