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OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response...... 0.5
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FORM 3 U.S. SECURITIES AND EXCHANGE COMMISSION
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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*
Bosma Roger
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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. Date of Event Requiring Statement (Month/Day/Year) 6/2/99
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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 Lakeland Bancorp, Inc.
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5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
[X] Director [X] Officer [ ] 10% Owner [ ] Other
(give title below) (specify below)
President & CEO of Lakeland Bancorp, Inc.
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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)
X Form Filed by One Reporting Person
____ Form filed by More than One Reporting Person
TABLE I--NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
<TABLE>
<CAPTION>
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1. Title 2. Amount of 3. Ownership Form: 4. Nature of
of Securities Bene- Direct (D) or Indirect Bene-
Security ficially Owned Indirect (I) ficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5)
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<S> <C> <C> <C>
Lakeland Bancorp 1,000 shares D Owned solely by
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Common Stock purchased 5/11/99 Roger Bosma
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@$16.75
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
If form is filed by more than one reporting person, see Instruction 5(b)(v).
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FORM 3 (continued)
TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
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1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conversion 5. Ownership 6. Nature of In-
Security (Instr. 4) cisable and Underlying Derivative Security or Form of direct Bene-
Expiration (Instr. 4) Exercise Derivative ficial
Date Price Security: Ownership
(Month/Day/ of Direct (D) (Instr. 5)
Year) Derivative or In-
---------------------------------------------------- Security direct (I)
Date Expira- Amount or (Instr. 5)
Exer- tion Title Number of
cisable Date Shares
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<S> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Explanation of Responses:
**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 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.
/s/ Roger Bosma 6-8-99
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**Signature of Reporting Person Date
