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Page Lawrence – ‘3’ for 6/28/04 re: Google Inc.

On:  Monday, 6/28/04, at 7:17pm ET   ·   For:  6/28/04   ·   As:  Director, Officer and 10% Owner   ·   Accession #:  1181431-4-32636   ·   File #:  0-50726

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 6/28/04  Page Lawrence                     3          D,O,%Owner  2:8K   Google Inc.                       R R Donnelley … Filer/FA

Initial Statement of Beneficial Ownership of Securities by an Insider   —   Form 3   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 3           Form 3 for Page Dated 6/28/04 -- rrd46291.xml/2.2   HTML      6K 
 2: EX-24       Power of Attorney                                   HTML      5K 

‘3’   —   Form 3 for Page Dated 6/28/04 — rrd46291.xml/2.2

This ‘3’ Document is an XML Data File that may be rendered in various formats:

  Form 3    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File

SEC Info rendering:  Form 3 for Page Dated 6/28/04
Washington, D.C. 20549


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 Number:3235-0104
Estimated average burden
hours per response:0.5
1. Name and Address of Reporting Person*
Page Lawrence



2. Date of Event Requiring Statement (Month/Day/Year)
3. Issuer Name and Ticker or Trading Symbol
Google Inc. [ NONE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
XDirectorX10% Owner
XOfficer (give title below) Other (specify below)
Pres, Products, Asst. Secty
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
XForm 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)
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 ExercisableExpiration DateTitleAmount or Number of Shares
Series A Preferred Stock 6/28/04 (1) 6/28/04 (1)Class B Common Stock435,2000.0625D
Class B Common Stock (2) 6/28/04 (2) 6/28/04 (2)Class A Common Stock36,658,5000.00 (2)D
Class B Common Stock (2) 6/28/04 (2) 6/28/04 (2)Class A Common Stock1,500,0000.00 (2)IBy Trust
Explanation of Responses:
(1)  Each share of Series A Preferred Stock shall be automatically converted into one share of Class B Common Stock upon the closing of the Issuer's initial public offering to occur at a later date and has no expiration date.
(2)  Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder.
/s/ Matthew Tolland as attorney-in-fact 6/28/04
** Signature of Reporting PersonDate
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.
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.

Filing Submission 0001181431-04-032636   –   Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)

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