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FORM 15
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 0-23472
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Pacific Rehabilitation & Sports Medicine, Inc.
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(Exact name of registant as specified in its charter)
3850 N. Wilke Road, Suite 200, Arlington Heights, IL 60004
(847) 670-5600
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(Address, including zip code, and telephone number, including area code,
of registrant's principal executive offices)
Common Stock, $0.01 par value
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(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 12b-3(b)(1)(ii) [ ]
Rule 12g-4(a)(1)(ii) [ ] Rule 12b-3(b)(2)(i) [ ]
Rule 12g-4(a)(2)(i) [ ] Rule 12b-3(b)(2)(ii) [ ]
Rule 12g-4(a)(2)(ii) [ ] Rule 15d-6 [ ]
Rule 12h-3(b)(1)(i) [ ]
Approximate number of holders of record as of the certification or notice
date:
1
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Pursuant to the requirements of the Securities Exchange Act of 1934
(NAME OF REGISTRANT AS SPECIFIED IN CHARTER) has caused this
certification/notice to be signed on its behalf by the undersigned duly
authorized person.
DATE: May 2, 1997 BY: Michael McArthur-Phillips
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Michael McArthur-Phillips, Secretary
Pacific Rehabilitation & Sports Medicine, Inc.
INSTRUCTIONS. 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.
