Statement of Changes in Beneficial Ownership (4)
06 Juli 2021 - 11:40PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Dulany Eric Edward |
2. Issuer Name and Ticker or Trading Symbol
Amplify Energy Corp.
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AMPY
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) SEE REMARKS |
(Last)
(First)
(Middle)
C/O AMPLIFY ENERGY CORP., 500 DALLAS STREET SUITE 1700 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
7/1/2021 |
(Street)
HOUSTON, TX 77002
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, par value $0.01 per share | 7/1/2021 | | A | | 29116 | A | (1) | 29116 | 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. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Explanation of Responses: |
(1) | Share amount reflects an aggregate number and represents 29,116 unvested restricted stock units with service-based vesting conditions ("TSUs"). These TSUs were granted under the Amplify Energy Corp. Equity Incentive Plan and vest periodically so long as the reporting person remains employed by Amplify Energy Corp. or one of its affiliates on each applicable vesting date. The TSUs convert into common stock on a one-for-one basis. |
Remarks: VICE PRESIDENT AND CHIEF ACCOUNTING OFFICER |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Dulany Eric Edward C/O AMPLIFY ENERGY CORP. 500 DALLAS STREET SUITE 1700 HOUSTON, TX 77002 |
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| SEE REMARKS |
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Signatures
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/s/ Eric M. Willis | | 7/6/2021 |
**Signature of Reporting Person | Date |
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