0001006655-16-000156.txt : 20161205 0001006655-16-000156.hdr.sgml : 20161205 20161205173911 ACCESSION NUMBER: 0001006655-16-000156 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161204 FILED AS OF DATE: 20161205 DATE AS OF CHANGE: 20161205 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: EVOLUTION PETROLEUM CORP CENTRAL INDEX KEY: 0001006655 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 411781991 STATE OF INCORPORATION: NV FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 1155 DAIRY ASHFORD ST. STREET 2: SUITE 425 CITY: HOUSTON STATE: TX ZIP: 77079 BUSINESS PHONE: 713-935-0122 MAIL ADDRESS: STREET 1: 1155 DAIRY ASHFORD ST. STREET 2: SUITE 425 CITY: HOUSTON STATE: TX ZIP: 77079 FORMER COMPANY: FORMER CONFORMED NAME: NATURAL GAS SYSTEMS INC/NEW DATE OF NAME CHANGE: 20040817 FORMER COMPANY: FORMER CONFORMED NAME: NATURAL GAS SYSTEMS, INC. DATE OF NAME CHANGE: 20040810 FORMER COMPANY: FORMER CONFORMED NAME: REALITY INTERACTIVE INC DATE OF NAME CHANGE: 19960301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Keys Randall D CENTRAL INDEX KEY: 0001050736 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32942 FILM NUMBER: 162034697 MAIL ADDRESS: STREET 1: 3 HICKORY SHADOWS DR CITY: HOUSTON STATE: TX ZIP: 77055 FORMER NAME: FORMER CONFORMED NAME: KEYS RANDALL D DATE OF NAME CHANGE: 19971203 4 1 wf-form4_148097753932375.xml FORM 4 X0306 4 2016-12-04 0 0001006655 EVOLUTION PETROLEUM CORP EPM 0001050736 Keys Randall D 1155 DAIRY ASHFORD, SUITE 425 HOUSTON TX 77079 0 1 0 0 President and CEO Common Stock 2016-12-04 4 F 0 4810 9.30 D 279570 D Shares surrendered to the Company to pay income tax withholding obligations. /s/ Randall D. Keys 2016-12-05