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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Convertible Note | $ 1.5 | 06/30/2005 | J(3) | 2,333,333 | 06/30/2005 | 06/30/2006 | Common Stock | 2,333,333 | $ 0 | 2,333,333 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SAMSON OIL & GAS N.L. LEVEL 36 EXCHANGE PLAZA 2 THE ESPLANADE PERTH, C3 6000 |
X |
/s/ Denis I. Rakich, Company Secretary | 07/06/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | The Reporting Person exchanged shares of its stock for shares of the Issuer held by non-U.S. residents. |
(2) | Based on the value of the shares exchanged by the Reporting Person at the time of the exchange. |
(3) | The Reporting Person was issued a convertible note by the Issuer in the principal amount of $3,500,000 evidencing a revolving loan in the same amount. The note is convertible by the Reporting Person for all or any portion of the unpaid principal and interest owed at $1.50 per share of the Issuer, initially 2,333,333 shares based on the principal amount. Because, the amount of unpaid principal and interest varies from time to time, the actual number of shares into which the note may be converted will likewise vary. |