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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 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 001-12129
MEDICAL ASSURANCE, INC.
(Exact name of registrant as specified in its charter)
100 Brookwood Place, Birmingham, Alabama 35209; (205) 877-4400
(Address, including zip code, and telephone number,
including area code, of registrant's principal executive offices)
Common Stock, par value $1.00 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) [X] Rule 12h-3(b)(1)(i) [X]
Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(1)(ii) [ ]
Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(i) [ ]
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: One.
Pursuant to the requirements of the Securities Exchange Act of 1934,
Medical Assurance, Inc. has caused this certification/notice to be signed on its
behalf by the undersigned duly authorized person.
Date: June 28, 2001 By: /s/ A. Derrill Crowe
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A. Derrill Crowe, M.D., President
Instruction: This form is required by Rules 12g-4, 12h-3 and 15d-6 of the
General Rules and Regulations under the Securities 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.