15-15D 1 form15.txt FORM 15 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: 333-81837 The Doty Agency, Inc. 401(k) Plan (Exact name of registrant as specified in its charter) German American Bank, Trustee 711 Main Street, Box 810 Jasper, Indiana 47546-3042 812-482-1314 (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) Common shares, German American Bancorp, no par value (Title of each class of securities covered by the Form) None (Title 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)(ii) [ ] Rule 12g-4(a)(1)(ii)[ ] Rule 12h-3(b)(2)(i) [ ] Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(ii) [ ] Rule 12g-4(a)(2)(ii)[ ] Rule 15d-6 [ X ] Rule 12h-3(b)(1)(i) [ ] Approximate number of holders of record as of the certification or notice date: one. This form is filed to report the suspension of the registrant's duty to file reports as a result of the merger of the registrant into the German American Bancorp Employees' Profit Sharing Plan effective June 1, 2001. Pursuant to the requirements of the Securities Exchange Act of 1934, the German American Bancorp Employees' Profit Sharing Plan, as successor by merger to The Doty Agency, Inc. 401(k) Plan, has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person. THE GERMAN AMERICAN BANCORP EMPLOYEES' PROFIT SHARING PLAN GERMAN AMERICAN BANK, TRUSTEE By: /s/ Bonnie S. Hochgesang ------------------------------------------- Bonnie S. Hochgesang, AVP & T.O. Date: June 26, 2001