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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
 
 
XML Data rendering:  Form 3 for Page Dated 6/28/04
 
                                                                                                                                                                                
<?xml version="1.0" encoding="windows-1252"?>
<ownershipDocument>
<schemaVersion> X0202 </schemaVersion>
<documentType> 3 </documentType>
<periodOfReport> 2004-06-28 </periodOfReport>
<noSecuritiesOwned> 0 </noSecuritiesOwned>
<issuer>
<issuerCik> 0001288776 </issuerCik>
<issuerName> Google Inc. </issuerName>
<issuerTradingSymbol> NONE </issuerTradingSymbol>
</issuer>
<reportingOwner>
<reportingOwnerId>
<rptOwnerCik> 0001295231 </rptOwnerCik>
<rptOwnerName> Page Lawrence </rptOwnerName>
</reportingOwnerId>
<reportingOwnerAddress>
<rptOwnerStreet1> C/O GOOGLE INC. </rptOwnerStreet1>
<rptOwnerStreet2> 1600 AMPHITHEATRE PARKWAY </rptOwnerStreet2>
<rptOwnerCity> MOUNTAIN VIEW </rptOwnerCity>
<rptOwnerState> CA </rptOwnerState>
<rptOwnerZipCode> 94043 </rptOwnerZipCode>
<rptOwnerStateDescription></rptOwnerStateDescription>
</reportingOwnerAddress>
<reportingOwnerRelationship>
<isDirector> 1 </isDirector>
<isOfficer> 1 </isOfficer>
<isTenPercentOwner> 1 </isTenPercentOwner>
<isOther> 0 </isOther>
<officerTitle> Pres, Products, Asst. Secty </officerTitle>
</reportingOwnerRelationship>
</reportingOwner>
<derivativeTable>
<derivativeHolding>
<securityTitle>
<value> Series A Preferred Stock </value>
</securityTitle>
<conversionOrExercisePrice>
<value> 0.0625 </value>
</conversionOrExercisePrice>
<exerciseDate>
<value> 2004-06-28 </value>
<footnoteId id="F1"/>
</exerciseDate>
<expirationDate>
<value> 2004-06-28 </value>
<footnoteId id="F1"/>
</expirationDate>
<underlyingSecurity>
<underlyingSecurityTitle>
<value> Class B Common Stock </value>
</underlyingSecurityTitle>
<underlyingSecurityShares>
<value> 435200 </value>
</underlyingSecurityShares>
</underlyingSecurity>
<ownershipNature>
<directOrIndirectOwnership>
<value> D </value>
</directOrIndirectOwnership>
</ownershipNature>
</derivativeHolding>
<derivativeHolding>
<securityTitle>
<value> Class B Common Stock </value>
<footnoteId id="F2"/>
</securityTitle>
<conversionOrExercisePrice>
<value> 0.00 </value>
<footnoteId id="F2"/>
</conversionOrExercisePrice>
<exerciseDate>
<value> 2004-06-28 </value>
<footnoteId id="F2"/>
</exerciseDate>
<expirationDate>
<value> 2004-06-28 </value>
<footnoteId id="F2"/>
</expirationDate>
<underlyingSecurity>
<underlyingSecurityTitle>
<value> Class A Common Stock </value>
</underlyingSecurityTitle>
<underlyingSecurityShares>
<value> 36658500 </value>
</underlyingSecurityShares>
</underlyingSecurity>
<ownershipNature>
<directOrIndirectOwnership>
<value> D </value>
</directOrIndirectOwnership>
</ownershipNature>
</derivativeHolding>
<derivativeHolding>
<securityTitle>
<value> Class B Common Stock </value>
<footnoteId id="F2"/>
</securityTitle>
<conversionOrExercisePrice>
<value> 0.00 </value>
<footnoteId id="F2"/>
</conversionOrExercisePrice>
<exerciseDate>
<value> 2004-06-28 </value>
<footnoteId id="F2"/>
</exerciseDate>
<expirationDate>
<value> 2004-06-28 </value>
<footnoteId id="F2"/>
</expirationDate>
<underlyingSecurity>
<underlyingSecurityTitle>
<value> Class A Common Stock </value>
</underlyingSecurityTitle>
<underlyingSecurityShares>
<value> 1500000 </value>
</underlyingSecurityShares>
</underlyingSecurity>
<ownershipNature>
<directOrIndirectOwnership>
<value> I </value>
</directOrIndirectOwnership>
<natureOfOwnership>
<value> By Trust </value>
</natureOfOwnership>
</ownershipNature>
</derivativeHolding>
</derivativeTable>
<footnotes>
<footnote id="F1"> 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. </footnote>
<footnote id="F2"> Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder. </footnote>
</footnotes>
<ownerSignature>
<signatureName> /s/ Matthew Tolland as attorney-in-fact </signatureName>
<signatureDate> 2004-06-28 </signatureDate>
</ownerSignature>
</ownershipDocument>


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