Initial Statement of Beneficial Ownership (3)
March 23 2017 - 6:29PM
Edgar (US Regulatory)
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
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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
*
Lovins Gregory
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2. Date of Event Requiring Statement (MM/DD/YYYY)
3/20/2017
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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 AVENUE
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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)
V.P. and Interim CFO /
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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)
_
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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7642
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D
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Common Stock (Savings Plan)
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1925.3469
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I
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Savings Plan
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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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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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958
(1)
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$0
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D
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2015 MSU Award
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2/25/2016
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2/28/2019
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Common Stock
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2707
(1)
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$0
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D
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2016 MSU Award
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2/23/2017
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2/27/2020
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Common Stock
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2468
(1)
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$0
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D
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2017 MSU Award
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2/22/2018
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2/25/2021
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Common Stock
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2705
(1)
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$0
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D
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2015 PU Award
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2/22/2018
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2/22/2018
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Common Stock
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5027
(2)
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$0
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D
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2016 PU Award
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2/28/2019
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2/28/2019
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Common Stock
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3836
(3)
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$0
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D
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2017 PU Award
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2/27/2020
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2/27/2020
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Common Stock
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3114
(4)
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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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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 at each vesting date is based on the percentage change in the Company's stock price, plus dividend equivalents accrued during the vesting period. Each marked leveraged stock unit represents a contingent right to receive one share of Avery Dennison Corporation common stock, plus dividend equivalents.
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(
2)
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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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(
3)
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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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(
4)
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Performance units vest, if at all, at the end of fiscal year 2019, provided certain Company performance objectives are met as determined in February 2020. 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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Lovins Gregory
207 GOODE AVENUE
GLENDALE, CA 91203
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V.P. and Interim CFO
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Signatures
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/s/ Erica Perry POA for Gregory Lovins
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3/23/2017
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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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