<PAGE> 1
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
Sections 13 and 15(d) of the Securities Exchange Act of 1934.
DOMINICK'S SUPERMARKETS, INC.
(Exact name of registrant as specified in its charter)
1-12353
(Commission File Number)
505 RAILROAD AVENUE
NORTHLAKE, ILLINOIS 60164
(708) 562-1000
(Address, including zip code, and telephone number, including
area code, of registrant's principal executive offices)
COMMON STOCK, PAR VALUE $.01 PER SHARE
NON-VOTING COMMON STOCK, PAR VALUE $.01 PER SHARE
(Title of each class of securities covered by this Form)
NONE
(Titles of all other classes of securities for which a duty to
file reports under section 13(a) of 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 12g-4(a)(1)(ii) [ ]
Rule 12g-4(a)(2)(i) [ ]
Rule 12g-4(a)(2)(ii) [ ]
Rule 12h-3(b)(1)(i) [X]
Rule 12h-3(b)(1)(ii) [ ]
Rule 12h-3(b)(2)(i) [ ]
Rule 12h-3(b)(2)(ii) [ ]
Rule 15d-6 [ ]
Approximate number of holders of record as of the certification or notice date:
Common Stock - 1
Non-Voting Common Stock- 1
Safeway Inc. ("Safeway") is the sole holder of record of the securities listed
above as of the date hereof pursuant to the merger of Windy City Acquisition
Corp., a wholly-owned subsidiary of Safeway, with and into Dominick's
Supermarkets, Inc. ("Dominick's") which was consummated on November 19, 1998.
<PAGE> 2
2
Pursuant to the requirements of the Securities Exchange Act of 1934, Dominick's
has caused this certification/notice to be signed on its behalf by the
undersigned duly authorized person.
DOMINICK'S SUPERMARKETS, INC.
BY: /s/ MARK HUSSEY
-------------------------
Name: Mark Hussey
Title: Vice President-
Division Financial Officer
DATE: November 20, 1998
