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 SUPENSION OF DUTY TO FILE REPORTS UNDER
SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
Commission File Number: 0-265520
California Independent Bancorp
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(Exact name of registrant as specified in its charter)
1227 Bridge St., Suite C, Yuba City, California 95991
(530) 674-6025
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(Address, including zip code, and
telephone number, including area
code, of registrant's principal
executive offices)
Common Stock, no par value
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(Title of each class of securities covered by this form)
None
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(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: 0
Pursuant to the requirements of the Securities Exchange Act of 1934, as
amended, CALIFORNIA INDEPENDENT BANCORP has caused this certification/notice to
be signed on its behalf by the undersigned duly authorized person.
DATE: January 6, 2004 By: /s/ John I. Jelavich
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Name: John I. Jelavich
Title: President and Chief Executive Officer