SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Casalena Anthony

(Last) (First) (Middle)
C/O SQUARESPACE, INC.,
225 VARICK STREET, 12TH FLOOR

(Street)
NEW YORK NY 10014

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/10/2021
3. Issuer Name and Ticker or Trading Symbol
Squarespace, Inc. [ SQSP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class A Common Stock 2,750,000(1) D
Class A Common Stock 600,000 I See footnote(2)
Class A Common Stock 1,139,142 I See footnote(3)
Class A Common Stock 4,460,858(4) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock (5) (5) Class A Common Stock 2,050,838 (5) I See footnote(2)
Class B Common Stock (5) (5) Class A Common Stock 40,835,572 (5) I See footnote(3)
Explanation of Responses:
1. Represents restricted stock units, each of which represents a contingent right to receive one share of the Issuer's Class A Common Stock upon satisfaction of a service-based vesting condition and the achievement of stock price goals.
2. The shares are held of record by the Anthony Casalena 2019 Family Trust.
3. The shares are held of record by the Anthony Casalena Revocable Trust.
4. These shares of Class A Common Stock are subject to forfeiture if certain liquidity events with respect to the Issuer, including the sale of Class A Common Stock pursuant to the Issuer's Registration Statement on Form S-1, have not been completed prior to August 22, 2021. Upon the first sale of Class A Common Stock to the general public pursuant to the Issuer's Registration Statement on Form S-1, the performance conditions associated with this Class A Common Stock would be met.
5. Each share of the Issuer's Class B Common Stock is convertible into one share of the Issuer's Class A Common Stock upon the option of the holder and has no expiration date.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Jessica Krasner, as Attorney-in-Fact 05/10/2021
** 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 5 (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.
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