SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Sherer Lori

(Last) (First) (Middle)
200 SMITH RANCH ROAD

(Street)
SAN RAFAEL CA 94903

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FAIR ISAAC CORP [ FIC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Vice President
3. Date of Earliest Transaction (Month/Day/Year)
12/02/2004
4. 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 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 Following Reported Transaction(s) (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
Common Stock 12/02/2004 M 25,313 A $17.6593 37,364.3285(1) D
Common Stock 12/02/2004 M 33,750 A $26.2845 71,114.3285 D
Common Stock 12/02/2004 M 11,250 A $29.2 82,364.3285 D
Common Stock 12/02/2004 S 800 D $34.08 81,564.3285 D
Common Stock 12/02/2004 S 6,200 D $34.09 75,364.3285 D
Common Stock 12/02/2004 S 12,100 D $34.1 63,264.3285 D
Common Stock 12/02/2004 S 10,200 D $34.11 53,064.3285 D
Common Stock 12/02/2004 S 6,200 D $34.12 46,864.3285 D
Common Stock 12/02/2004 S 300 D $34.13 46,564.3285 D
Common Stock 12/02/2004 S 1,700 D $34.14 44,864.3285 D
Common Stock 12/02/2004 S 22,113 D $34.15 22,751.3285 D
Common Stock 12/02/2004 S 10,700 D $34.16 12,051.3285 D
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. Transaction 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 Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-Qualified Stock Option (right to buy) $17.6593 12/02/2004 M 25,313 04/09/2002(2) 04/09/2011 Common Stock 25,313 $0.00 8,437 D
Non-Qualified Stock Option (right to buy) $26.2845 12/02/2004 M 33,750 11/30/2002(2) 11/30/2011 Common Stock 33,750 $0.00 11,250 D
Non-Qualified Stock Option (right to buy) $29.2 12/02/2004 M 11,250 11/29/2003(2) 11/29/2012 Common Stock 11,250 $0.00 11,250 D
Explanation of Responses:
1. Common stock holdings include ESPP purchase and reinvested dividends.
2. This option vests in four equal annual installments commencing on this date.
Remarks:
Lori Sherer 12/03/2004
** 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).
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