SEC

Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
Check this box if no longer subject to Washington, D.C. 20549 OMB Number: 3235-0362
Section 16. Form 4 or Form 5
obligations may continue. See
Estimated average burden

Instruction 1(b). ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP hours per response: 1.0

Form 3 Holdings Reported.

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934

Form 4 Transactions Reported. or Section 30(h) of the Investment Company Act of 1940

1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 5. Relationship of Reporting Person(s) to Issuer

Musk Elon Tesla, Inc. [ TSLA ] (Check all applicable)

X Director X 10% Owner

3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
(Last) (First) (Middle) Officer (give title Other (specify
12/31/2021 X below) below)
C/O TESLA, INC.
CEO
13101 TESLA ROAD
4. If Amendment, Date of Original Filed (Month/Day/Year) 6. Individual or Joint/Group Filing (Check Applicable Line)

(Street) X Form filed by One Reporting Person

AUSTIN TX 78725 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 2A. Deemed 3. 4. Securities Acquired (A) or Disposed Of 5. Amount of 6. Ownership 7. Nature of
Date Execution Date, Transaction (D) (Instr. 3, 4 and 5) Securities Form: Direct Indirect
(Month/Day/Year) if any Code Beneficially Owned (D) or Beneficial
(Month/Day/Year) (Instr. 8) at end of Issuer's Indirect (I) Ownership
(A) or
Amount Price Fiscal Year (Instr. (Instr. 4) (Instr. 4)
(D)
3 and 4)

Common Stock 11/19/2021 G(1) 2,234,000 D $0.00 175,418,251 I By Trust

Common Stock 11/22/2021 G(1) 1,560,000 D $0.00 173,858,251 I By Trust

Common Stock 11/23/2021 G (1) 500,000 D $0.00 173,358,251 I By Trust

Common Stock 11/24/2021 G (1)

500,000 D $0.00 172,858,251 I By Trust

Common Stock 11/29/2021 G(1) 250,000 D $0.00 172,608,251 I By Trust

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned

(e.g., puts, calls, warrants, options, convertible securities)
1. Title of 2. 3. Transaction 3A. Deemed 4. 5. Number of 6. Date Exercisable and 7. Title and 8. Price of 9. Number of 10. 11. Nature
Derivative Conversion Date Execution Date, Transaction Derivative Expiration Date Amount of Derivative derivative Ownership of Indirect
Security or Exercise (Month/Day/Year) if any Code Securities (Month/Day/Year) Securities Security Securities Form: Beneficial
(Instr. 3) Price of (Month/Day/Year) (Instr. 8) Acquired (A) Underlying (Instr. 5) Beneficially Direct (D) Ownership
Derivative or Disposed Derivative Security Owned or Indirect (Instr. 4)
Security of (D) (Instr. (Instr. 3 and 4) Following (I) (Instr.
3, 4 and 5) Reported 4)
Transaction(s)
Amount (Instr. 4)
or
Number
Date Expiration of
(A) (D) Exercisable Date Title Shares

Explanation of Responses:
1. Represents a bona fide gift of the Issuer's common stock by the Reporting Person to charity

Remarks:

By: Aaron Beckman by Power

02/14/2022
of Attorney For: Elon Musk
** 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 4 (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.