FORM 5
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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.
Brown Melvin H |
2. Issuer Name and
Ticker or Trading Symbol Electronic Systems Technology Inc |
Relationship
of Reporting Person to Issuer (Check all Applicable) __X___ Director _______ 10% Owner |
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(Last) (First) (Middle) 460 Lakeview Dr. |
3. IRS
Identification Number of Reporting Person at an entity (Voluntary) |
4. Statement for
(Month/Year) 12/2001 |
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(Street) Burbank WA 99323 |
5. If Amendment; Date of Original (Month/Year) | 7. Individual or
Joint/Group Reporting (check applicable line) _X__Form Filed by One Reporting Person |
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(City) (State) (Zip) | Table 1 Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 3.Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3,4 and 5) | 5. Amount of Securities
Beneficially Owned at end of Issuers Fiscal Year (Instr. 3 & 4) |
6. Ownership Forum Direct (D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Amount |
(A) or (D) |
Price | |||||||
COMMON | 76,500 | D | |||||||
*If the form is filed by more that one Reporting Person see Instruction 4(b)(v).
FORM 5
(Continued)
Table II Derivative Securities Acquired, Disposed of, or
Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative
Securities Acquired (A) or Disposed (D) (Instr. 3,4 & 5) |
6. Date Exercisable and Expiration Date (Month Day/Year) | 7. Title and Amount of Underlying Securities (Instr. 3 & 4) | 8. Price of Derivative security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Year (Instr. 4) | 10. Ownership of Derivative
Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Date Exercisable |
Expiration Date |
Title |
Amount of Number of Shares |
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(A) | (D) | ||||||||||||
OPTIONS | 2/12/99 | 2/11/02 | Common | 25,000 | $0.44 | 25,000 | D | ||||||
OPTIONS | 2/11/00 | 2/11/03 | Common | 25,000 | $2.81 | 25,000 | D | ||||||
OPTIONS | 2/9/01 | 2/9/04 | Common | 25,000 | $0.44 | 25,000 | D | ||||||
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)
/s/ MELVIN BROWN
Feb 12, 2002
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** Signature of Reporting Person
Date