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*
LucasZoom LLC

(Last) (First) (Middle)
3000 SAND HILL ROAD, BUILDING 1,
SUITE 170

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/29/2021
3. Issuer Name and Ticker or Trading Symbol
LEGALZOOM.COM, INC. [ LZ ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 1,475,300 D(1)(2)
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
Series A Redeemable Convertible Preferred Stock (3) (3) Common Stock 36,537,688 (3) D(1)(2)
1. Name and Address of Reporting Person*
LucasZoom LLC

(Last) (First) (Middle)
3000 SAND HILL ROAD, BUILDING 1,
SUITE 170

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Permira V L.P.2

(Last) (First) (Middle)
P.O. BOX 503, TRAFALGAR COURT, LES
BANQUES, ST PETER PORT

(Street)
Y7 GY1 6DJ

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Permira V G.P. L.P.

(Last) (First) (Middle)
P.O. BOX 503, TRAFALGAR COURT, LES
BANQUES, ST PETER PORT

(Street)
Y7 GY1 6DJ

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Permira V G.P. Ltd

(Last) (First) (Middle)
P.O. BOX 503, TRAFALGAR COURT, LES
BANQUES, ST PETER PORT

(Street)
Y7 GY1 6DJ

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Lucazoom Sarl

(Last) (First) (Middle)
488, ROUTE DE LONGWY

(Street)
N4 L-1940

(City) (State) (Zip)
Explanation of Responses:
1. As of the date hereof, LucasZoom, LLC owns 1,475,300 shares of common stock and 18,268,844 shares of Series A redeemable convertible preferred stock of the Issuer (the "Subject Securities"). Lucazoom S.a.r.l. ("Lucazoom") is the sole member of LucasZoom, LLC. Permira V L.P.2 ("Permira V") is the controlling shareholder of Lucazoom. Permira V GP L.P. ("Permira V GP") is the general partner of Permira V. Permira V GP Limited (together with Lucazoom, Permira V and Permira V GP, the "Permira Entities") is the general partner of Permira V GP.
2. The Permira Entities may be deemed to share voting and dispositive power over the Subject Securities held by LucasZoom, LLC but disclaim such beneficial ownership except to the extent of their pecuniary interest therein.
3. Each share of the Issuer's Series A redeemable convertible preferred stock is convertible at any time into two shares of the Issuer's common stock at the option of the holder, and will automatically convert into shares of the Issuer's common stock on a one-for-two basis upon completion of the Issuer's initial public offering and concurrent private placement.
Remarks:
Dipan Patel and Brian Ruder currently serve on the board of directors of the Issuer as the Reporting Persons' representatives, and therefore the Reporting Persons may be deemed a "director by deputization" of the Issuer.
/s/ Brian Ruder By: Brian Ruder, President, Chief Executive Officer and Secretary, LucasZoom, LLC 06/29/2021
/s/ Severine Michel By: Severine Michel, Manager, Lucazoom S.a.r.l. 06/29/2021
/s/ Julie Preece By: Julie Preece, Director for Permira V GP Limited, general partner of Permira V GP L.P., general partner of Permira V L.P.2 06/29/2021
/s/ Julie Preece By: Julie Preece, Director for Permira V GP Limited, general partner of Permira V GP L.P. 06/29/2021
/s/ Julie Preece By: Julie Preece, Director for Permira V GP Limited 06/29/2021
** 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).
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