Initial Statement of Beneficial Ownership (3)
04 Février 2022 - 2:46PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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0.5
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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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1. Name and Address of Reporting Person
*
Bayless Rebecca L |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/25/2022
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3. Issuer Name and Ticker or Trading Symbol
Riley Exploration Permian, Inc. [REPX]
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(Last)
(First)
(Middle)
C/O RILEY EXPLORATION PERMIAN, INC., 29 E. RENO, SUITE 500 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
OKLAHOMA CITY, OK 73104
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock, par value $0.001 per share | 5468 (1) | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | These shares are restricted stock acquired under Issuer's Riley Exploration Permian, Inc. 2021 Long Term Incentive Plan on January 25, 2022 (the "Grant Date"). 100% of the shares of restricted stock vest on the first anniversary of the Grant Date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Bayless Rebecca L C/O RILEY EXPLORATION PERMIAN, INC. 29 E. RENO, SUITE 500 OKLAHOMA CITY, OK 73104 | X |
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Signatures
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/s/ Rebecca L. Bayless | | 2/4/2022 |
**Signature of Reporting Person | Date |
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