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: 1-11733
American States Financial Corporation
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
500 North Meridian Street, Indianapolis, Indiana 46204
(317) 262-6262
(ADDRESS, INCLUDING ZIP CODE, AND TELEPHONE NUMBER,
INCLUDING AREA CODE, OF REGISTRANT'S
PRINCIPAL EXECUTIVE OFFICES)
Common Stock, no par value per share
(TITLE OF EACH CLASS OF SECURITIES COVERED BY THIS FORM)
None
(TITLES OF ALL OTHER CLASSES OF SECURITIES FOR WHICH A DUTY TO
FILE 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
file reports:
Rule 12g-4(a)(1)(i) [x] Rule 12h-3(b)(1)(ii) [ ]
Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(2)(i) [ ]
Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(ii) [ ]
Rule 12g-4(a)(2)(ii) [ ] Rule 15d-6 [ ]
Rule 12h-3(b)(1)(i) [x]
Approximate number of holders of record as of the
certification or notice date: 1
Pursuant to the requirements of the Securities Exchange Act
of 1934, American States Financial Corporation has caused this
certification/notice to be signed on its behalf by the
undersigned duly authorized person.
DATE: October 1, 1997 BY: /s/ Thomas M. Ober
Name: Thomas M. Ober
Title: Secretary
Instruction: This form is required by Rules 12g-4, 12h-3 and
15d-6 of the General Rules and Regulations under the Securities
Exchange Act of 1934. The registrant shall file with the
Commission three copies of Form 15, one of which shall be
manually signed. It may be signed by an officer 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.
