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.
Kirchner Tom L |
2. Issuer Name and
Ticker or Trading Symbol Electronic Systems Technology Inc. ELST |
Relationship
of Reporting Person to Issuer (Check all Applicable) __X___ Director _______ 10% Owner President/CEO |
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(Last) (First) (Middle) 354 W. Adair Dr. |
3. IRS
Identification Number of Reporting Person at an entity (Voluntary) |
4. Statement for
(Month/Year) 12/2001 |
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(Street) Richland WA 99352 |
5. If Amendment; Date of Original (Month/Year) | 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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(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 Form Direct(D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Amount | (A) or (D) |
Price | |||||||
COMMON | 403,488 | 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 | ||||||||||
(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/ T. L. KIRCHNER Feb 12, 2002
_______________________________ ___________
** Signature of Reporting Person Date