- Termination of Registration of a Class of Security under Section 12(g) (15-12G)
October 25 2012 - 9:12AM
Edgar (US Regulatory)
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
000-11709
First Citizens National Bank Employee
Stock Ownership Plan and Trust and
Payroll Stock Ownership Plan
(Exact name of registrant as specified in its charter)
One
First Citizens Place
Dyersburg,
Tennessee 38024
(731)
285-4410
(Address, including zip code,
and telephone number,
including area code, of registrants principal executive offices)
Plan Interests
(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)
|
¨
|
|
Rule
12g-4(a)(2)
|
¨
|
|
Rule
12h-3(b)(1)(i)
|
x
|
|
Rule 12h-3(b)(1)(ii)
|
¨
|
|
Rule 15d-6
|
¨
|
* Explanatory Note
: In accordance with the approach taken in Emerson
Electric Co. (available January 5, 1994), the registrant is suspending its reporting obligations
under section 15(d) of the Securities Exchange Act of 1934, as amended.
Approximate number of
holders of record
as of the certification or
notice date:
353
Pursuant to the requirements of the Securities Exchange Act of 1934,
First Citizens National Bank Employee Stock Ownership Plan and Trust and Payroll
Stock Ownership Plan has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.
|
First Citizens National Bank
Employee Stock Ownership Plan and Trust and
|
|
Payroll Stock Ownership Plan
|
|
|
Date:
October
25, 2012
|
By:
/s/
Judy Burns
|
|
Judy Burns, Plan Trustee
|
|
|
|
|
Date:
October
25, 2012
|
By:
/s/ Kerrie Heckethorn
|
|
Kerrie Heckethorn, Plan Administrator
|
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