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OMB APPROVAL
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OMB Number 3235-0362
Expires: December 31, 2001
Estimated average burden
hours per response ....... 1.0
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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
[X] Check this 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 Holdings Reported
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1. Name and Address of Reporting Person*
Quilty Edward J.
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(Last) (First) (Middle)
214 Carnegie Center, Suite 100
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(Street)
Princeton, NJ 08540
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Palatin Technologies, Inc. (PTN)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
06/00
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[ ] Officer (give title below) [X] Other (specify below)
Former director and officer
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7. Individual or Joint/Group Reporting
(check applicable line)
[X] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
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<TABLE>
<CAPTION>
Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form:
3. (Instr. 3, 4 and 5) Owned at End Direct 7.
2. Trans- ---------------------------- of Issuer's (D) or Nature of
1. Transaction action (A) Fiscal Year Indirect Indirect
Title of Security Date (Month/ Code or (Instr. 3 (I) Beneficial
(Instr. 3) Day/Year) (Instr. 8) Amount (D) Price and 4) (Instr. 4) Ownership
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
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* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v).
</TABLE>
Persons who respond to the collection of information contained in this form are
not required to respond unless the form displays a currently valid OMB control
number.
Page 1 of 3
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<TABLE>
<CAPTION>
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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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>
stock option common
(right to buy) $0.20 07/08/99 A 176,460 07/08/99 06/13/04 stock 176,460 Note 1 176,460 D
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stock option common
(right to buy) $3.125 12/09/99 A 100,000 06/13/00 06/13/04 stock 100,000 Note 2 100,000 D
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</TABLE>
Explanation of Responses:
(1) Anti-dilution option granted as compensation without cash consideration.
(2) Option granted as incentive compensation without cash consideration.
/s/ Edward J. Quilty August 7, 2000
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**Signature of Reporting Person Date
By: Raymond C. Hedger, Jr.
Attorney-in-Fact
** 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 control number.
Page 2 of 3
<PAGE>
ATTACHMENT:
July 25, 2000
CONFIRMATION STATEMENT
I, Edward J. Quilty, hereby authorize and designate Hedger & Hedger, by
Raymond C. Hedger, Jr. or Samantha J. Prince, to file on my behalf with the
United States Securities and Exchange Commission any of the following documents
relative to my ownership, purchase or sale of the securities of Palatin
Technologies, Inc.: (1) Form 4 - Statement of Changes in Beneficial Ownership,
(2) Form 5 - Annual Statement of Changes in Beneficial Ownership, (3) Schedule
13D and (4) Schedule 13G.
Date: July 12, 2000 /s/ Edward J. Quilty
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Edward J. Quilty
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