Initial Statement of Beneficial Ownership (3)
August 08 2016 - 2:57PM
Edgar (US Regulatory)
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FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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STANDER DEON
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2. Date of Event Requiring Statement (MM/DD/YYYY)
8/2/2016
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3. Issuer Name
and
Ticker or Trading Symbol
Avery Dennison Corp [AVY]
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(Last)
(First)
(Middle)
207 GOODE AVE.
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
VP/General Manager, RBIS /
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(Street)
GLENDALE, CA 91203
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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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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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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8599
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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2012 Employee Stock Option
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2/23/2013
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2/23/2022
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Common Stock
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6031
(1)
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$30.50
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D
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2013 MSU Award
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2/27/2014
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2/23/2017
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Common Stock
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1539
(2)
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$0
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D
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2014 MSU Award
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2/26/2015
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2/22/2018
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Common Stock
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2556
(2)
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$0
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D
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2014 PU Award
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2/27/2017
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2/27/2017
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Common Stock
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5342
(3)
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$0
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D
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2015 MSU Award
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2/26/2016
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2/28/2019
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Common Stock
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4031
(2)
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$0
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D
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2015 PU Award
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2/26/2018
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2/26/2018
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Common Stock
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4991
(4)
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$0
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D
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2015 RSU Award
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9/1/2016
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9/1/2018
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Common Stock
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8100
(5)
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$0
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D
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2016 MSU Award
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2/25/2017
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2/27/2020
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Common Stock
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2880
(2)
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$0
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D
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2016 PU Award
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2/25/2019
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2/25/2019
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Common Stock
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10069
(6)
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$0
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D
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Explanation of Responses:
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(
1)
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The stock options vest in four cumulative installments on the first, second, third and fourth anniversaries of the grant date.
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(
2)
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Market leveraged stock units vest 25% over one-, two-, three- and four-year performance periods using a conversion formula under which the number of shares earned is adjusted at each vesting date based on the percentage change in the Company's stock price plus dividend equivalents accrued during the vesting period. Each market leveraged stock unit represents a contingent right to receive one share of the Company's common stock, plus dividend equivalents.
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(
3)
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Performance units vest, if at all, at the end of fiscal year 2016, provided certain Company performance objectives are met as determined in February 2017. Each performance unit represents a contingent right to receive one share of Avery Dennison Corporation common stock.
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(
4)
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Performance units vest, if at all, at the end of fiscal year 2017, provided certain Company performance objectives are met as determined in February 2018. Each performance unit represents a contingent right to receive one share of Avery Dennison Corporation common stock.
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(
5)
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The restricted stock units vest in three cumulative installments on the first, second and third anniversaries of the date of grant. Each restricted stock unit represents a contingent right to receive one share of Avery Dennison Corporation common stock.
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(
6)
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Performance units vest, if at all, at the end of fiscal year 2018, provided certain Company performance objectives are met as determined in February 2019. Each performance unit represents a contingent right to receive one share of Avery Dennison Corporation common stock.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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STANDER DEON
207 GOODE AVE.
GLENDALE, CA 91203
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VP/General Manager, RBIS
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Signatures
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/s/ Erica Perry POA for Deon Stander
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8/8/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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