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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 Section 13 and 15(d) of
the Securities Exchange Act of 1934
Commission File Number 0-4707
Beverly Bancorporation, Inc.
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(Exact name of registrant as specified in its charter)
16345 S. Harlem Ave.
Suite 3E
Tinley Park, IL 60477
(708) 614-5070
(Address, including zip code, and telephone number, including area code, of
registrant's principal executive offices)
COMMON STOCK, $.01 PAR VALUE PER SHARE
(Title of each class of securities covered by this Form)
NONE
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(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,
Beverly Bancorporation, Inc. has caused this certification/notice to be
signed on its behalf by the undersigned duly authorized person.
Date: July 1, 1998 By: /s/ Jeffrey M. Voss
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Jeffrey M. Voss
Executive Vice President
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.
