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 1-13809
AquaPenn Spring Water Company, Inc.
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(Exact name of registrant as specified in its charter)
One AquaPenn Drive, P.O. Box 938, Milesburg, Pennsylvania 16853, (814) 355-5556
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(Address, including zip code, and
telephone number, including area code,
of registrant's principal executive offices)
Common Stock, no par value
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(Title of each class of securities covered by this Form)
None
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(Title 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 on notice date: 1
Pursuant to the requirements of the Securities Exchange Act of 1934,
AquaPenn Spring Water Company, Inc., has caused this certification/notice to be
signed on its behalf by the undersigned duly authorized person.
Dated: December 10, 1998 By: /S/ MARK RODRIGUEZ
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Mark Rodriguez
Chief Executive Officer
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.
