/------------------------------/
/ OMB APPROVAL /
/------------------------------/
/ OMB Number 3235-0362 /
/ Expires: February 1, 1994 /
/ Estimated average burden /
/ hours per response...... 1.0 /
/------------------------------/
+--------+ U.S. SECURITIES AND EXCHANGE COMMISSION
| FORM 5 | Washington, D.C. 20549
+--------+
[_] Check box if
no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
to Section 16.
Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities
obligations may Exchange Act of 1934, Section 17(a) of the
continue. See Public Utility Holding Company Act of 1935 or
Instruction 1(b). Section 30(1) of the Investment Company Act of 1940
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
--------------------------------------------------------------------------------
1. Name and Address of Reporting Person
Fredericks Mark J
----------------------------------------------------------------------------
(Last) (First) (Middle)
c/o Lakeland Bancorp, Inc.
250 Oak Ridge Road
----------------------------------------------------------------------------
(Street)
Oak Ridge New Jersey 07438
----------------------------------------------------------------------------
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol Lakeland Bancorp, Inc.
-----------------------------------
3. IRS or Social Security Number of Reporting Person, (Voluntary) 154-62-7287
-----------
4. Statement for Month/Year 12/31/00
---------------------------------------------------
5. If Amendment, Date of Original (Month/Year) Dec-00
--------------------------------
6. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [_] Officer [_] 10% Owner [_] Other
(Title Below) (Specify Below)
1.34%
----------------
-------------------------------------------------------------------------------
Table 1--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
-------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7 . Nature
(Instr. 3) action action or Disposed of (D) Securities Form: of Indirect
Date Code (Instr. 3, 4, and 5) Beneficially Direct Beneficial
(Month/ (Instr. 8) Owned at (D) or Ownership
Lakeland Bancorp, Inc. Day/ End of Indirect (Instr. 4)
Year) Issuer's (I)
(A) or Fiscal Year (Instr. 4)
Amount (D) Price (Instr. 3 and 4)
------------------------------------------------------------------------------------------------------------------------------------
Common 02/15/00 DRP 330 A $12.5000 D *1
------------------------------------------------------------------------------------------------------------------------------------
05/15/00 DRP 373 A $11.1190 D *1
------------------------------------------------------------------------------------------------------------------------------------
DRP 356 A $11.7140 D *1
------------------------------------------------------------------------------------------------------------------------------------
250 A N/K D *1
------------------------------------------------------------------------------------------------------------------------------------
250 A D *1
------------------------------------------------------------------------------------------------------------------------------------
2215 A D *1
------------------------------------------------------------------------------------------------------------------------------------
410 A D *1
------------------------------------------------------------------------------------------------------------------------------------
586 A 59724 D *1
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
------------------------------------------------------------------------------------------------------------------------------------
FORM 5 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants,options, convertible securities)
M. Fredricks
-----------------------------------------------------------------------------------------------------------------------------
1. Title of Derivative 2. Conver- 3. Transaction 4. Transac- 5. Number of Deriv-
Security (Instr. 3) sion or Date tion Code ative Securities
Exercise (Month/ (Instr. 8) Acquired (A) or
Price of Day/ Disposed (D)
Derivative Year) (Instr. 3, 4, and 5)
Security
---------------------------
(A) (D)
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Ownership 11. Nature
cisable and Underlying Securities of of Derivative of Derivative of Indirect
Expiration (Instr. 3 and 4) Derivative Securities Security: Beneficial
Date Security Beneficially Direct Ownership
(Month/Day/ (Instr. 5) Owned (D) or (Instr. 4)
Year) at End Indirect (1)
of Year (Instr. 4)
-------------------------------------------- (Instr. 4)
Date Expira- Amount or
Exer- tion Title Number of
cisable Date Shares
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
------------------------
* 1- Solely owned by Mark J. Fredericks
CODES
DRP - Dividend Reinvestment Plan
S/D - Stock Dividend
G - Gift
/s/ Mark Fredericks 01/26/01
-------------------------------- -----------------
**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. 7811(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.