SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O TESLA, INC|
|3500 DEER CREEK ROAD|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
[ TSLA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|Chief Accounting Officer||
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||By: Aaron Beckman, Power of Attorney For: David Morton
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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.|
LIMITED POWER OF ATTORNEY - SECURITIES LAW COMPLIANCE
The undersigned, as an Officer of Tesla, Inc. (the "Company"),
hereby constitutes and appoints Todd Maron, Jonathan Chang,
Yun Huh, Aaron Beckman and each of them, the undersigned's true
and lawful attorney-in-fact and agent to complete and execute
such Forms 144, Forms 3, 4 and 5 and other forms as such
attorney shall in his discretion determine to be required or
advisable pursuant to Rule 144 promulgated under the Securities
Act of 1933 (as amended), Section 16 of the Securities Exchange
Act of 1934 (as amended) and the rules and regulations
promulgated thereunder, or any successor laws and regulations,
as a consequence of the undersigned's ownership, acquisition or
disposition of securities of the Company, and to do all acts
necessary in order to file such forms with the Securities and
Exchange Commission, any securities exchange or national
association, the Company and such other person or agency as the
attorney shall deem appropriate. The undersigned hereby ratifies
and confirms all that said attorneys-in-fact and agents shall do
or cause to be done by virtue hereof.
This Limited Power of Attorney shall remain in full force and
effect until the undersigned
is no longer required to file Forms
3, 4 and 5 with respect to the undersigned's holdings of and
transactions in securities issued by the Company unless earlier
revoked by the undersigned in a writing delivered to the
This Limited Power of Attorney is executed at 6800 Dumbarton
Circle, Fremont CA 94555, as of the date set forth below.
August 7, 2018