Fillable Printable Form 15

Form 15

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 15

CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION

12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE

REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

Commission File Number ___________________________

__________________________________________________________________________________________________

(Exact name of registrant as specied in its charter)

__________________________________________________________________________________________________

(Address, including zip code, and telephone number, including area code, of registrant’s principal executive ofces)

__________________________________________________________________________________________________

(Title of each class of securities covered by this Form)

__________________________________________________________________________________________________

(Titles of all other classes of securities for which a duty to le reports under section 13(a) or 15(d) remains)

Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the

duty to le reports:

Rule 12g-4(a)(1)

Rule 12g-4(a)(2)

Rule 12h-3(b)(1)(i)

Rule 12h-3(b)(1)(ii)

Rule 15d-6

Rule 15d-22(b)

Approximate number of holders of record as of the certication or notice date: _______________________________

Pursuant to the requirements of the Securities Exchange Act of 1934 (Name of registrant as specied in charter) has

caused this certication/notice to be signed on its behalf by the undersigned duly authorized person.

Date: _______________________________ By: ___________________________________________________________

Instruction: This form is required by Rules 12g-4, 12h-3 and 15d-6 and 15d-22 of the General Rules and Regulations under

the Securities Exchange Act of 1934. The registrant shall le with the Commission three copies of Form 15, one of which

shall be manually signed. It may be signed by an ofcer of the registrant, by counsel or by any other duly authorized person.

The name and title of the person signing the form shall be typed or printed under the signature.

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