SEC Form 4
FORM 4
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject toSection 16. Form 4 or Form 5 obligationsmay continue.
See
Instruction 1(b).
1. Name and Address of Reporting Person
*
Sandberg Sheryl
(Last)(First)(Middle)
C/O FACEBOOK, INC.1601 WILLOW ROAD
(Street)
MENLO PARKCA94025
(City)(State)(Zip)2. Issuer Name
and
Ticker or Trading Symbol
Facebook Inc[
FB
]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
X
Director10% Owner
X
Officer (give titlebelow)Other (specifybelow)
Chief Operating Officer
3. Date of Earliest Transaction (Month/Day/Year)
10/31/2012
4. If Amendment, Date of Original Filed (Month/Day/Year)6. Individual or Joint/Group Filing (Check Applicable Line)
X
Form filed by One Reporting PersonForm filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
2. TransactionDate(Month/Day/Year)2A. DeemedExecution Date,if any(Month/Day/Year)3.TransactionCode (Instr.8)4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)5. Amount of SecuritiesBeneficially OwnedFollowing ReportedTransaction(s)(Instr. 3 and 4)6. OwnershipForm: Direct(D) or Indirect(I) (Instr. 4)7. Nature of IndirectBeneficialOwnership(Instr. 4)CodeVAmount(A) or (D)Price
Class A Common Stock10/31/2012
C
7,780
(1)
A
$
0.007,780IBy SherylK.Sandberg,Trustee of theSandberg-GoldbergFamilyTrustdatedSeptember 3, 2004
(2)
Class A Common Stock10/31/2012
C
1,892,206
(1)
A
$
0.001,892,206IBy SherylK.Sandberg,Trustee of the SherylK.Sandberg2008AnnuityTrustdatedApril 15,2008
(3)
Class A Common Stock10/31/2012
S
(4)
13,392D
$