15-12B 1 form15.txt FORM 15 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 001-09662 Placer Dome Inc. ------------------------------------------------------ (Exact name of registrant as specified in its charter) Suite 1600, 1055 Dunsmuir Street P.O. Box 49330, Bentall Postal Station Vancouver, British Columbia Canada V7X 1P1 (604) 682-7082 ------------------------------------------------------------- (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) 8 5/8% Junior Subordinated Debentures due December 31, 2045, Series A --------------------------------------------------------------------- (Title of each class of securities covered by this Form) Common Shares; Common Share Purchase Rights -------------------------------------------------------------------------- (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)(i) [ ] Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(1)(ii) [ ] Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(i) [X] Rule 12g-4(a)(2)(ii) [ ] Rule 12h-3(b)(2)(ii) [ ] Rule 15d-6 [ ] Approximate number of holders of record as of the certification or notice date: 0 * * * Pursuant to the requirements of the Securities Exchange Act of 1934, Placer Dome Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person. Date: August 20, 2003 PLACER DOME INC. By: /s/Geoffrey P. Gold ------------------- Geoffrey P. Gold Vice-President, Assistant Secretary and Associate General Counsel