Form 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |
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OMB Number: 3235-0362 |
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Expires: January 31, 2005 |
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Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See instructions 1(b). |
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[ ] | Form 3 Holdings Reported | ||
[ X ] | Form 4 Transactions Reported |
1. Name and Address of Reporting
Person*
Anderson, Ray C. |
2. Issuer Name and Ticker
or Trading Symbol
Interface, Inc. (IFSIA) |
6. Relationship of Reporting Person(s) to Issuer Chairman of the Board | ||||||||
(Last) (First) (Middle)
2859 Paces Ferry Road, Suite 2000 |
3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) |
4. Statement for Month/Year 12/29/02 | ||||||||
(Street)
Atlanta, Georgia 30339 |
5. If Amendment, Date of Original (Month/Year)
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7. Individual or Joint/Group Filing (Check Applicable Line) _X_ Form filed by One Reporting Person ___ Form filed by More than One Reporting Person | ||||||||
(City) (State) (Zip) |
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 at the end of Issuer's Fiscal Year (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 | ||||||
Class A Common Stock | 09-17-01 | P4 | 1,000 | A | $5.80 |
13,500 |
I | Spouse(1) | ||
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* If the form is filed by more than one reporting person, see instruction 4(b)(v).
Form 5 (continued) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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. Trans- action 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 |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Year (Instr. 4) |
10. Ownership of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares |
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Explanation of
Responses:
(1) The reporting person disclaims beneficial ownership of the shares held by his spouse. |
/s/ Ray C. Anderson Ray C. Anderson **Signature of Reporting Person |
02-04-03
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** | 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 |