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
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
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*
MORITZ MICHAEL J

(Last) (First) (Middle)
C/O SEQUOIA CAPITAL
3000 SAND HILL ROAD, BUILDING 4

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Google Inc. [ GOOG ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/24/2004
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
Class A Common Stock(1) 11/09/2004 C 6,496,485 A $0 6,496,485 I Sequoia Capital VIII
Class A Common Stock(1) 11/09/2004 C 82,435 A $0 82,435 I Sequoia International Technology Partners VIII
Class A Common Stock(1) 11/09/2004 C 430,087 A $0 430,087 I Sequoia International Technology Partners VIII(Q)
Class A Common Stock 11/23/2004 J(2) 2,165,495 D $0 4,330,990 I Sequoia Capital VIII
Class A Common Stock 11/23/2004 J(2) 27,478 D $0 57,957 I Sequoia International Technology Partners VIII
Class A Common Stock 11/23/2004 J(2) 143,362 D $0 286,725 I Sequoia International Technology Partners VIII(Q)
Class A Common Stock 11/23/2004 J(3) 91,975 A $0 91,975 D
Class A Common Stock 11/30/2004 J(2) 2,165,495 D $0 2,165,495 I Sequoia Capital VIII
Class A Common Stock 11/30/2004 J(2) 27,478 D $0 27,479 I Sequoia International Technology Partners VIII
Class A Common Stock 11/30/2004 J(2) 143,362 D $0 143,363 I Sequoia International Technology Partners VIII(Q)
Class A Common Stock 11/30/2004 J(3) 150,799 A $0 242,774 D
Class A Common Stock 12/07/2004 J(2) 2,165,495 D $0 0 I Sequoia Capital VIII
Class A Common Stock 12/07/2004 J(2) 27,479 D $0 0 I Sequoia International Technology Partners VIII
Class A Common Stock 12/07/2004 J(2) 143,363 D $0 0 I Sequoia International Technology Partners VIII(Q)
Class A Common Stock 12/07/2004 J(3) 150,799 A $0 301,598 D
Class A Common Stock(1) 01/31/2005 C 14,182,641 A $0 14,182,641 I Sequoia Capital VIII
Class A Common Stock(1) 01/31/2005 C 182,088 A $0 182,088 I Sequoia International Technology Partners VIII
Class A Common Stock(1) 01/31/2005 C 934,029 A $0 934,029 I Sequoia International Technology Partners VIII(Q)
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
Series B Preferred Stock $0 08/24/2004 C 477,872 08/24/2004 08/24/2004 Class B Common Stock 477,872 $0 0 I CMS Partners LLC
Series B Preferred Stock $0 08/24/2004 C 52,568 08/24/2004 08/24/2004 Class B Common Stock 52,568 $0 0 I Sequoia 1997
Series B Preferred Stock $0 08/24/2004 C 21,654,952 08/24/2004 08/24/2004 Class B Common Stock 21,654,952 $0 0 I Sequoia Capital VIII
Series B Preferred Stock $0 08/24/2004 C 274,784 08/24/2004 08/24/2004 Class B Common Stock 274,784 $0 0 I Sequoia International Technology Partners VIII
Series B Preferred Stock $0 08/24/2004 C 1,433,624 08/24/2004 08/24/2004 Class B Common Stock 1,433,624 $0 0 I Sequoia International Technology Partners VIII(Q)
Class B Common Stock $0 08/24/2004 C 477,872 08/24/2004 (4) Class A Common Stock 477,872 $0 477,872 I CMS Partners LLC
Class B Common Stock $0 08/24/2004 C 52,568 08/24/2004 (4) Class A Common Stock 52,568 $0 52,568 I Sequoia 1997
Class B Common Stock $0 08/24/2004 C 21,654,952 08/24/2004 (4) Class A Common Stock 21,654,952 $0 21,654,952 I Sequoia Capital VIII
Class B Common Stock $0 08/24/2004 C 274,784 08/24/2004 (4) Class A Common Stock 274,784 $0 274,784 I Sequoia International Technology Partners VIII
Class B Common Stock $0 08/24/2004 C 1,433,624 08/24/2004 (4) Class A Common Stock 1,433,624 $0 1,433,624 I Sequoia International Technology Partners VIII(Q)
Class B Common Stock $0 11/09/2004 C 6,496,485 11/09/2004 (4) Class A Common Stock 6,496,485 $0 15,158,467 I Sequoia Capital VIII
Class B Common Stock $0 11/09/2004 C 82,435 11/09/2004 (4) Class A Common Stock 82,435 $0 192,349 I Sequoia International Technology Partners VIII
Class B Common Stock $0 11/09/2004 C 430,087 11/09/2004 (4) Class A Common Stock 430,087 $0 1,003,537 I Sequoia International Technology Partners VIII(Q)
Class B Common Stock $0 01/31/2005 C 14,182,641 01/31/2005 (4) Class A Common Stock 14,182,641 $0 975,826 I Sequoia Capital VIIISequoia Capital VIII
Class B Common Stock $0 01/31/2005 C 182,088 01/31/2005 (4) Class A Common Stock 182,088 $0 10,261 I Sequoia International Technology Partners VIII
Class B Common Stock $0 01/31/2005 C 934,029 01/31/2005 (4) Class A Common Stock 934,029 $0 69,508 I Sequoia International Technology Partners VIII(Q)
Explanation of Responses:
1. Each share of Class A Common Stock was issued upon the conversion of one share of Class B Common Stock at the election of Reporting Person.
2. Distribution by Sequoia entities. Mr. Moritz disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein as affected by his distributive shares noted in footnote 3.
3. Shares received upon distribution by Sequoia entities.
4. There is no expiration date for the Issuer's Class B Common Stock.
Matthew M. Tolland as attorney-in-fact for Michael Moritz 02/02/2005
** 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).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.