Form 5

 

Form 5

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

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[   ] Form 3 Holdings Reported  
[   ] Form 4 Transactions Reported  

1.  Name and Address of Reporting Person*

 Coombs, Robert A.

 2. Issuer Name and Ticker or Trading Symbol

Interface, Inc. (IFSIA)

6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
      Director                                10% Owner
  X   Officer (give                     Other (specify
                  title below)                     below)

Vice President

(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)

 

 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

                  

        

     
       

 

        

   

 

   
                 

 

    
         

 

        

       

 

  
                     

* 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
(e.g., puts, calls, warrants, options, convertible securities)

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
    Amount of
    Underlying
    Securities
    (Instr. 3
    and 4)

 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)
       

 

(A)

(D)

Date
Exercisable

Expiration
Date

Title

 Amount
or
Number
of Shares
Employee
Stock
Option
(right to
buy)

$6.375

 3/01/01

  

 A5

A

  

 3/01/02(1)

  3/01/11

 Class A or
Class B
Common
Stock

 50,000

50,000

D

  











































Explanation of Responses:

(1) The option vests and becomes exercisable at the rate of 20% per year; the first increment (10,000 shares) became exercisable on March 1, 2002.

 

   /s/  Robert Coombs

Robert Coombs

**Signature of Reporting Person

  02-07-03

Date

 

** 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