OMB
APPROVAL
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3235-0167
November 30, 2010
1.50
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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
000-52558
Disaboom, Inc
(Exact
name of registrant as specified in its charter)
7730 E.
Belleview Avenue, Suite A-306
Greenwood
Village, CO 80111
(303) 952-6500
(Address,
including zip code, and telephone number, including area code, of registrant’s
principal executive offices)
Common Stock, $0.0001 par
value
(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:
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Rule
12g-4(a)(1)
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x
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Rule
12g-4(a)(2)
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o
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Rule
12h-3(b)(1)(i)
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o
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Rule
12h-3(b)(1)(ii)
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x
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Rule 15d-6
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o
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Approximate
number of holders of record as of the certification or notice date:
235
Pursuant to
the requirements of the Securities Exchange Act of 1934 (Name of registrant as
specified in charter) has caused this certification/notice to be signed on its
behalf by the undersigned duly authorized person.
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Date:
December 31, 2009
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By:
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/s/ John
Walpuck
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Name:
John Walpuck
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Title:
Chief Executive Officer and Chief Financial
Officer
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Instruction: This
form is required by Rules 12g-4, 12h-3 and 15d-6 of the General Rules and
Regulations under the Securities Exchange 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.
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