mdsm_15d12h.htm
UNITED
STATES
SECURITIES
AND EXC HANGE 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 333-100137
(Exact
name of registrant as specified in its charter)
2223
West Pecos Road, Suite 6, Chandler, AZ 85224 (877)
372-7836
(Address,
including zip code, and telephone number, including area code, of registrant’s
principal executive offices)
Common
Stock $0.0001 par value
(Title of
each class of securities covered by this Form)
(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)
|
[ ]
|
Rule
12g-4(a)(2)
|
[ ]
|
Rule
12h-3(b)(1)(i)
|
[X]
|
Rule
12h-3(b)(1)(ii)
|
[ ]
|
Rule
15d-6
|
[ ]
|
Approximate number of holders of record
as of the certification or notice date: 116
Pursuant to the requirements of the
Securities Exchange Act of 1934, Medistem Inc. has caused this
certification/notice to be signed on its behalf by the undersigned duly
authorized person.
Date:
November 25,
2008 By: /s/ Steven
M. Rivers
Steven
M. Rivers, Chief Financial Officer
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.
Persons
who respond to the collection of information contained
in
this form are not required to respond unless the form displays
a
currently valid OMB control number