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 AND EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY
TO FILE REPORTS UNDER SECTIONS 12 AND 15(d) OF THE SECURITIES EXCHANGE
ACT OF 1934.
Timberlodge Steakhouse, Inc.
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(Exact name of registrant as specified in its charter)
4021 Vernon Avenue South
St. Louis Park, Minnesota 55416
(612) 929-9353
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(Address, including zip code, and telephone number,
including, area code, of registrant's principal
executive offices)
Common Stock
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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 of 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) [ ]
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 certificate 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: September __, 1999 By: /s/ Theodore Abajian
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Chief Financial Officer
Timberlodge Steakhouse, Inc.
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 mutually 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.
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