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(Print or Type Responses)
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*
Phelps, Carlton T.
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(Last) (First) (Middle)
167 Schwenk Drive
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(Street)
Kingston, NY 12401
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
August 15, 2000
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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
Image Technology Laboratories, Inc. (IMTL)
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5. Relationship of Reporting Persons to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
CFO, Secretary and Treasurer
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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
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Table I -- Non-Derivative Securities Beneficially Owned
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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. 5)
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Common Stock 2,429,583 D
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Preferred Stock 500,000 D
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(Over)
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Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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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- Securities:
(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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Options * 1/1/10 Common Stock 1,000,000 $0.33 D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
Explanation of Responses:
/s/ Carlton T. Phelps March 30, 2001
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**Signature of Reporting Person Date
* If the form is filed by more than one reporting person, see Instruction
5(b)(v).
** 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.
*200,000 are exercisable as of January 1, 2001
200,000 are exercisable as of January 1, 2002
200,000 are exercisable as of January 1, 2003
200,000 are exercisable as of January 1, 2004
200,000 are exercisable as of January 1, 2005