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1
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NAME OF REPORTING PERSONS
Estate of Sam J. Jacobsen
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
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(a) ¨
(b) o
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
Wisconsin
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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5
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SOLE VOTING POWER
7
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6
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SHARED VOTING POWER
0
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7
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SOLE DISPOSITIVE POWER
7
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8
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SHARED DISPOSITIVE POWER
0
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
7
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
Not Applicable
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o
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
<1%
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12
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
OO
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Item 1(a).
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Name of Issuer:
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First Business Financial Services, Inc.
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Item 1(b).
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Address of Issuer’s Principal Executive Offices:
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401 Charmany Drive, Madison, WI 53719
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Item 2(a).
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Name of Person Filing:
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Estate of Sam J. Jacobsen
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Item 2(b).
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Address of Principal Business Office or, if none, Residence:
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P.O. Box 620127, Middleton, WI 53562
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Item 2(c).
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Citizenship:
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United States
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Item 2(d).
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Title of Class of Securities:
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Common Stock (par value $.01 per share)
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Item 2(e).
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CUSIP Number:
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319390 10 0
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Item 3.
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If this statement is filed pursuant to sections 240.13d-1(b), or 240.13d-2(b) or (c), check whether the person filing is a:
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Not Applicable
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Item 4.
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Ownership (shares beneficially owned as of the date of this filing):
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(a)
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Amount Beneficially Owned: 7
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(b)
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Percent of Class: <1%
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(c)
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Number of shares as to which such person has:
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(i)
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sole power to vote or to direct the vote: 7
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(ii)
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shared power to vote or to direct the vote: 0
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(iii)
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sole power to dispose or to direct the disposition of: 7
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(iv)
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shared power to dispose or to direct the disposition of: 0
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Item 5.
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Ownership of Five Percent or Less of a Class:
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If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following T.
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Item 6.
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Ownership of More than Five Percent on Behalf of Another Person:
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Not Applicable
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Item 7.
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Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control Person:
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Not Applicable
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Item 8.
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Identification and Classification of Members of the Group:
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Not Applicable
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Item 9.
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Notice of Dissolution of Group:
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Not Applicable
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Item 10.
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Certification:
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By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
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In her fiduciary capacity and not in her personal or individual capacity
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