0001006655-16-000165.txt : 20161212 0001006655-16-000165.hdr.sgml : 20161212 20161212161622 ACCESSION NUMBER: 0001006655-16-000165 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161208 FILED AS OF DATE: 20161212 DATE AS OF CHANGE: 20161212 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: Dozier William CENTRAL INDEX KEY: 0001350032 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32942 FILM NUMBER: 162046452 MAIL ADDRESS: STREET 1: 3000 SAGE #1312 CITY: HOUSTON STATE: TX ZIP: 77056 4 1 wf-form4_148157737002039.xml FORM 4 X0306 4 2016-12-08 0 0001006655 EVOLUTION PETROLEUM CORP EPM 0001350032 Dozier William 1155 DAIRY ASHFORD, SUITE 425 HOUSTON TX 77079 1 0 0 0 Common Stock 2016-12-08 4 A 0 6418 9.35 A 132461 D Award of Restricted Stock pursuant to Company's 2004 Amended and Restated Stock Plan, as amended, subject to vesting. /s/ William Dozier 2016-12-12