15-15D 1 im04s1.txt FORM 15 UNITED STATES OF AMERICA 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: 333-85310-03 IMPAC SECURED ASSETS CORP MORTGAGE PASS THR CERT SER 2004-1 (Exact name of registrant as specified in its charter) 1401 Dove Street, Newport Beach, CA 92660 (949) 475-3600 (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) IMPAC SECURED ASSETS CORP. MORTGAGE PASS-THROUGH CERTIFICATES, SERIES 2004-1 CLASS A-1, CLASS A-2, CLASS A-3, CLASS A-4, CLASS A-5, CLASS A-6 CLASS A-IO, CLASS M-1, CLASS M-2 AND CLASS M-3 (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: Rule 12g-4(a)(1)(i) [X] Rule 12h-3(b)(1)(ii) [X] Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(2)(i) [ ] Rule 12g-4(a)(2)(i) [ ] Rule 12h-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: 10 SEE ATTACHED CERTIFICATION 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: January 26, 2005 By: /s/ Katherine M. Wannenmacher Katherine M. Wannenmacher Vice President Deutsche Bank National Trust Company, as Trustee 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. ACCOUNT HOLDER CERTIFICATION IMPAC SECURED ASSETS CORP. MORTGAGE PASS-THROUGH CERTIFICATES, SERIES 2004-1 Commission File Number: 333-85310-03 I hereby certify that the following information is correct: CERTIFICATE HOLDERS NAME OF SECURITY AS OF DECEMBER 31, 2004. CLASS A-1 1 CLASS A-2 1 CLASS A-3 1 CLASS A-4 1 CLASS A-5 1 CLASS A-6 1 CLASS A-IO 1 CLASS M-1 1 CLASS M-2 1 CLASS M-3 1 TOTAL 10 Date: January 26, 2005 Deutsche Bank National Trust Company, not in its individual capacity, but solely as a duly authorized agent of the Registrant pursuant to the Pooling and Servicing Agreement dated as of February 1, 2004. By: /s/ Katherine M. Wannenmacher Katherine M. Wannenmacher Vice President Deutsche Bank National Trust Company, as Trustee