SEC FORM 4 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 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Butier Mitchell R

(Last) (First) (Middle)
207 GOODE AVENUE

(Street)
GLENDALE CA 91203

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Avery Dennison Corp [ AVY ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President and COO
3. Date of Earliest Transaction (Month/Day/Year)
02/25/2016
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 Person
Form 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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (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 Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 02/25/2016 M 5,516 A $65.68 53,805 D
Common Stock 02/25/2016 F 2,801 D $65.68 51,004 D
Common Stock 02/25/2016 M 4,902 A $65.68 55,906 D
Common Stock 02/25/2016 F 1,843 D $65.68 54,063 D
Common Stock 02/25/2016 M 27,858 A $65.68 81,921 D
Common Stock 02/25/2016 F 14,557 D $65.68 67,364 D
Common Stock 02/25/2016 M 7,022 A $65.68 74,386 D
Common Stock 02/25/2016 F 2,639 D $65.68 71,747 D
Common Stock (Savings Plan) 3,617.3455 I Savings Plan
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
2013 MSU Award $0 02/25/2016 M 5,516(1) 02/27/2014 03/01/2017 Common Stock 5,516 $0 2,855 D
2014 MSU Award $0 02/25/2016 M 4,902(2) 02/26/2015 02/27/2018 Common Stock 4,902 $0 7,450 D
2015 MSU Award $0 02/25/2016 M 7,022(3) 02/26/2016 02/26/2019 Common Stock 7,022 $0 18,858 D
2013 PU Award $0 02/25/2016 M 27,858(4) 12/31/2015 03/01/2016 Common Stock 27,858 $0 0 D
2016 MSU Award $0 02/25/2016 A 30,169(5) 02/25/2017 02/25/2020 Common Stock 30,169 $0 30,169 D
2016 PU Award $0 02/25/2016 A 35,160(6) 02/25/2019 02/25/2019 Common Stock 35,160 $0 35,160 D
Explanation of Responses:
1. Shares reflect the vesting of the third tranche of market leveraged stock units granted in February 2013 at 179% of target based on our absolute total shareholder return during 2013-2015, plus dividend equivalents accrued during the period.
2. Shares reflect the vesting of the second tranche of market leveraged stock units granted in February 2014 at 125% of target based on our absolute total shareholder return during 2014-2015, plus dividend equivalents accrued during the period.
3. Shares reflect the vesting of the first tranche of market leveraged stock units granted in February 2015 at 109% of target based on our absolute total shareholder return in excess of 10% during 2015, plus dividend equivalents accrued during the period.
4. Shares reflect the vesting of performance units granted in February 2013 at 200% of target, 50% based on our cumulative economic value added and 50% on our relative total shareholder return performance objectives established for the award.
5. 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.
6. 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.
/s/ Erica Perry POA for Mitchell R Butier 02/29/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
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