Termination of Registration of a Class of Security Under Section 12(b) (15-12b)
October 10 2017 - 8:14AM
Edgar (US Regulatory)
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 SECTIONS 13 AND 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934.
Commission File Number 001-08183
SUPREME INDUSTRIES, INC.
(Exact name of registrant as specified
in its charter)
P.O. Box 237
2581 E. Kercher Road
Goshen, Indiana
(574) 642-3070
(Address, including zip code, and telephone
number, including area code, of registrant’s principal executive offices)
CLASS A COMMON STOCK, PAR VALUE $0.10
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) 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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Rule 12g-4(a)(1)
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x
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Rule 12g-4(a)(2)
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¨
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Rule 12h-3(b)(1)(i)
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x
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Rule 12h-3(b)(1)(ii)
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¨
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Rule 15d-6
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¨
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Approximate number of holders of record as of the certification
or notice date: 1
Pursuant to the requirements of the Securities Exchange Act
of 1934, Supreme Industries, Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized
person.
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Supreme Industries, Inc.
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Date: October 10, 2017
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By:
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/s/ Jeffery L. Taylor
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Name:
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Jeffery L. Taylor
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Title:
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Vice President
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