15-12G 1 0001.txt FORM 15 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 1-483 Mallinckrodt Inc. ------------------------------------------------------------------ (Exact name of registrant as specified in its charter) 675 McDonnell Boulevard, St. Louis, Missouri 63134 ------------------------------------------------------------ (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) Common Stock, $1.00 par value per share 4% Cumulative Preferred Stock, par value $100 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: Rule 12g-4(a)(1)(i) [ ] 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 [ ] Rule 12h-3(b)(1)(i) [X ] Approximate number of holders of record as of the certification or notice date: Description of Security Number of Holders ----------------------- ----------------- Common Stock, par value $1.00 per share 1 4% Cumulative Preferred Stock, par value $100 per share 126 Pursuant to the requirements of the Securities Exchange Act of 1934, Mallinckrodt Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person. DATE: November 14, 2000 MALLINCKRODT INC. By: /s/ C. Ray Holman ------------------------- Name: C. Ray Holman Title: Chief Executive Officer -2-