SEC FORM 3 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*
Guillen Jerome M

(Last) (First) (Middle)
C/O TESLA, INC
3500 DEER CREEK ROAD

(Street)
PALO ALTO CA 94304

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/26/2018
3. Issuer Name and Ticker or Trading Symbol
Tesla, Inc. [ TSLA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President, Automotive
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)
Common Stock 7,598 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
Incentive Stock Option (right to buy) (1) (1) Common Stock 1,370 363.8 D
Incentive Stock Option (right to buy) (2) (2) Common Stock 636 315.73 D
Non-Qualified Stock Option (right to buy) (3) (3) Common Stock 38,250 139.34 D
Non-Qualified Stock Option (right to buy) (4) (4) Common Stock 27,293 217.87 D
Non-Qualified Stock Option (right to buy) (1) (1) Common Stock 7,754 363.8 D
Non-Qualified Stock Option (right to buy) (5) (5) Common Stock 11,621 342.94 D
Non-Qualified Stock Option (right to buy) (2) (2) Common Stock 44,364 315.73 D
Restricted Stock Unit (6) (6) Common Stock 1,991 0.0 D
Restricted Stock Unit (7) (7) Common Stock 2,664 0.0 D
Explanation of Responses:
1. 1/48th of the shares subject to the option became vested and exercisable on September 14, 2017, and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter.
2. 1/60th of the shares subject to the option became vested and exercisable on March 12, 2018, and 1/60th of the shares subject to the option shall become vested and exercisable each month thereafter.
3. 1/4th of the shares subject to the option vested and became exercisable on each of October 6, 2015, May 15, 2017, and July 30, 2017, and the remainder of the shares subject to the option shall become vested and exercisable with the attainment of meeting the remaining performance goal specified in the option agreement.
4. 1/4th of the shares subject to the option vested and became exercisable on January 15, 2018, and the remainder of the shares subject to the option shall become vested and exercisable with the attainment of meeting the remaining performance goals specified in the option agreement.
5. 1/3rd of the shares subject to the option shall become vested and exercisable upon meeting each of three performance goals specified in the option agreement.
6. 1/16th of the total restricted stock units initially subject to this award vested on September 5, 2016, and 1/16th of the total units initially subject to this award vest every three months thereafter.
7. 1/16th of the total restricted stock units initially subject to this award vested on September 5, 2017, and 1/16th of the total units initially subject to this award vest every three months thereafter.
By: Aaron Beckman, Power of Attorney For: Jerome M. Guillen 10/03/2018
** 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.
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 
foregoing attorneys-in-fact.
This Limited Power of Attorney is executed at 3500 Deer Creek 
Road, Palo Alto CA 94304, as of the date set forth below.
/s/Jerome Guillen
WITNESS
Aaron Beckman
October 1, 2018