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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 15/A
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 0-14339
SYNERGEN, INC.
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
1885 33RD STREET
BOULDER, COLORADO 80301
(303) 938-6200
(ADDRESS, INCLUDING ZIP CODE, AND TELEPHONE NUMBER, INCLUDING AREA CODE, OF
REGISTRANT'S PRINCIPAL EXECUTIVE OFFICES)
WARRANTS TO PURCHASE COMMON STOCK
(TITLE OF EACH CLASS OF SECURITIES COVERED BY THIS FORM)
COMMON STOCK, $.01 PAR VALUE; RIGHTS TO PURCHASE SERIES A JUNIOR PARTICIPATING
PREFERRED STOCK;
CLASS A WARRANTS
(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:
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<S> <C> <C> <C>
Rule 12g-4(a)(1)(i) / / 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 12h-3(b)(1)(i) /X/ Rule 15d-6 /X/
</TABLE>
Approximate number of holders of record as of the certification or notice date:
185 HOLDERS OF WARRANTS TO PURCHASE COMMON STOCK
Pursuant to the requirements of the Securities Exchange Act of 1934
SYNERGEN, INC. has caused this certification/notice to be signed on its behalf
by the undersigned duly authorized person.
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<S> <C>
DATE: January 31, 1995 BY: /s/ Thomas E. Workman, Jr.
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Vice President, Secretary and
General Counsel
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