SEC Form 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
Mammoth Energy Services, Inc.
[ TUSK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Beneficially Owned|
|1. Title of Security (Instr.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||/s/ Mark Layton as attorney-in-fact for Paul K. Heerwagen IV
||** Signature of Reporting Person
|Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.|
|* If the form is filed by more than one reporting person,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).|
|Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.|
|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 Number.|
MAMMOTH ENERGY SERVICES, INC.
LIMITED POWER OF ATTORNEY FOR SECTION 13 AND SECTION 16 FILINGS
I, Paul K. Heerwagen IV, of 3001 Quail Springs Pkwy., Oklahoma City,
Oklahoma,73134 do hereby make, constitute and appoint Arty Straehla and Mark
Layton, my true and lawful attorneys for the purposes hereinafter set forth,
effective as of this 4th day of January, 2017.
References in this limited power of attorney to "my Attorneys" are to
the persons named above and to the person or persons substituted hereunder
pursuant to the power of substitution granted herein.
I hereby grant to each of my Attorneys, for me and in my name, place and
stead, the power:
1. To execute for and on my behalf, in my capacity as a stockholder of
Mammoth Energy Services, Inc., a Delaware corporation (the "Company"),
any Schedule 13D and Schedule 13G, and all and any amendments thereto,
in accordance with Section 13 of the Securities Exchange Act of 1934 and
the rules and regulations promulgated thereunder (the "Exchange Act");
2. To execute for and on my behalf, in my capacity as an officer, director
and/or stockholder of the Company, Form 3, Form 4, and Form 5, and all
and any amendments thereto, in accordance with Section 16(a) of the
3. To do and to perform any and all acts for and on my behalf that may be
necessary or desirable to complete and execute any such Schedule 13D,
Schedule 13G, Form 3, Form 4 and Form 5, or any amendment thereto, and
to timely file such schedule, form or amendment thereto with the United
States Securities and Exchange Commission (the "SEC") and any stock
exchange or similar authority; and
4. To take any other action of any type whatsoever that, in the opinion of
my Attorney, may be necessary or desirable in connection with the
foregoing grant of authority, it being understood that the documents
executed by my Attorney pursuant to this limited power of attorney shall
be in such form and shall contain such terms and conditions as my
Attorney may approve.
I hereby grant to my Attorneys full power and authority to do and to
perform any and every act and thing whatsoever requisite, necessary, or proper
to be done in the exercise of any of the rights and powers herein granted, as
fully to all intents and purposes as I might or could do if personally present,
with full power of substitution or revocation, hereby ratifying and confirming
all that my Attorneys shall lawfully do or cause to be done by virtue of this
limited power of attorney and the rights and powers herein granted. I
acknowledge and agree that neither my Attorneys nor the Company is assuming any
of my responsibilities to comply with the Exchange Act.
This limited power of attorney shall remain in full force and effect
until I am no longer required to file any Schedule 13D, Schedule 13G, Form 3,
Form 4 or Form 5 with respect to my holdings of, and transactions in, securities
of the Company, unless earlier revoked by me in a signed writing delivered to
each of my Attorneys and the substitutes therefore, if any. This limited power
of attorney may be filed with the SEC as a confirming statement of the authority
IN WITNESS WHEREOF, I have hereunto set my hand to this instrument on
the date first above written.
/s/ Paul K. Heerwagen IV
PAUL K. HEERWAGEN IV
STATE OF Oklahoma
COUNTY OF Oklahoma
Before me, Christina Allen , on this day personally appeared
Paul K. Heerwagen IV, known to me to be the person whose name is subscribed to
the foregoing instrument and acknowledged to me that he executed the same for
the purposes and consideration therein expressed.
Given under my hand and seal of office this 4 day of January, 2017.
/s/ Christina Allen
My Commission Expires: 10/17/18
[Affix Notary Seal]