Form 4 Hicks Ken C

4 - Statement of changes in beneficial ownership of securities

Published: 2012-10-02 12:10:14
Submitted: 2012-10-02
Period Ending In: 2012-09-28
form.html PRIMARY DOCUMENT


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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
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*
HICKS KEN C

(Last) (First) (Middle)
150 NORTH ORANGE GROVE BLVD

(Street)
PASADENA CA 91103

(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)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/28/2012
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 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
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
Common Stock Units $0 09/28/2012 A(1) 405.557 08/08/1988 08/08/1988 Common Stock 405.557 $0 6,997.549 I DDECP
Explanation of Responses:
1. Stock units were acquired by the reporting person pursuant to the Avery Dennison Corporation Non-Employee Director Deferred Equity Compensation Program in a transaction exempt under Rules 16a-11 and 16b-3(d).
/s/ Barbara Bartoletti POA for Ken C. Hicks 10/02/2012
** 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.
1
form.xml PRIMARY DOCUMENT
Schema Version:
X0306
Document Type:
4
Period Of Report:
2012-09-28
Not Subject To Section16:
false

Issuer

Issuer Cik
0000008818
Issuer Name
Avery Dennison Corp
Issuer Trading Symbol
AVY

Reporting Owner

Reporting Owner Id

Rpt Owner Cik
0001175746
Rpt Owner Name
HICKS KEN C

Reporting Owner Address

Rpt Owner Street1
150 NORTH ORANGE GROVE BLVD
Rpt Owner City
PASADENA
Rpt Owner State
CA
Rpt Owner Zip Code
91103

Reporting Owner Relationship

Is Director
true
Is Officer
false
Is Ten Percent Owner
false
Is Other
false

Derivative Transaction

Security Title
Common Stock Units
Conversion Or Exercise Price
0
Transaction Date
2012-09-28

Transaction Coding

Transaction Form Type
4
Transaction Code
A
Equity Swap Involved
false
@attributes Id
F1

Transaction Amounts

Transaction Shares
405.557
Transaction Price Per Share
0
Transaction Acquired Disposed Code
A
Exercise Date
1988-08-08
Expiration Date
1988-08-08

Underlying Security

Underlying Security Title
Common Stock
Underlying Security Shares
405.557
Shares Owned Following Transaction
6997.549

Ownership Nature

Direct Or Indirect Ownership
I
Nature Of Ownership
DDECP
Footnotes Footnote
Stock units were acquired by the reporting person pursuant to the Avery Dennison Corporation Non-Employee Director Deferred Equity Compensation Program in a transaction exempt under Rules 16a-11 and 16b-3(d).

Owner Signature

Signature Name
/s/ Barbara Bartoletti POA for Ken C. Hicks
Signature Date
2012-10-02
Additional Files
FileSequenceDescriptionTypeSize
0001246360-12-003916.txt   Complete submission text file   5634
$AVY

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