OMB APPROVAL
OMB Number: 3235-0167
Expires: November 30, 1995
Estimated average burden
hours per response....1.50
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 SECTION 13 AND 15(D) OF THE SECURITIES EXCHANGE ACT
OF 1934.
Commission File Number: 0-19713
VENTRITEX, INC.
- --------------------------------------------------------------------------------
(Exact name of registrant as specified in its charter)
701 East Evelyn Avenue, Sunnyvale, California 94086
- --------------------------------------------------------------------------------
(Address, including zip code, and telephone number, including area code,
of registrant's principal executive offices)
Common Stock, par value $0.001 per share
- --------------------------------------------------------------------------------
(Title of each class of securities covered by this Form)
5 3/4% Convertible Subordinated Notes due August 15, 2001
- --------------------------------------------------------------------------------
(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)(i) |X|
Rule 12g-4(a)(1)(ii) |_| Rule 12h-3(b)(1)(ii) |_|
Rule 12g-4(a)(2)(i) |_| Rule 12h-3(b)(2)(i) |_|
Rule 12g-4(a)(2)(ii) |_| Rule 12h-3(b)(2)(ii) |_|
Rule 15d-6 |_|
Approximate number of holders of record as of the certification or notice
date: 420
Pursuant to the requirements of the Securities Exchange Act of 1934
Ventritex, Inc. has caused this certification/notice to be signed on its behalf
by the undersigned duly authorized person.
Date: May 15, 1997 By: /s/ Mark Meltzer
------------------------------------
Vice President and General Counsel
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.
SEC 2069 (8-93)