15-12G 1 mediq-form15.txt CERTIFICATION AND NOTICE OF TERMINATION 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: 1-8147 MEDIQ, INCORPORATED ----------------------------------- (Exact name of registrant as specified in its charter) One MEDIQ Plaza, Pennsauken, New Jersey 08110; (856) 662-3200 ------------------------------------------------------------- (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) Series A 13% Cumulative Compounding Preferred Stock, par value $.01 ------------------------------------------------------------------- (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) [ ] 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 [X] Rule 12h-3(b)(1)(i) [ ] Approximate number of holders of record as of the certification or notice date: None SIGNATURE Pursuant to the requirements of the Securities Exchange Act of 1934, MEDIQ Incorporated has caused this certification notice to be signed on its behalf by the undersigned duly authorized person. MEDIQ Incorporated: Date: October 29, 2001 By: /s/Regis Farrell -------------------- Name: Regis Farrell Title: President