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:  000-54637


GREEN POLKADOT BOX INCORPORATED

(Exact name of registrant as specified in its charter)


Nevada

 

52-2325923

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification No.)

 

629 E. Quality Drive, Suite 103

American Fork, UT 84003

(801) 478-2500

 (Address, including zip code, and telephone number, including area code, of registrant’s principal executive offices)


Common Stock, par value $0.001

 (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)

x

Rule 15d-6

o

 

 

 

Rule 12g-4(a)(2)

o

 

 

 

 

 

Rule 12h-3(b)(1)(i)

x

 

 

 

 

 

Rule 12h-3(b)(1)(i)(ii)

o

 

 

 

 

 

 

 

 

 

 

 

 

Approximate number of holders of record as of the certification or notice date:

140

 

 

 














 


 

 

 

Pursuant to the requirements of the Securities Exchange Act of 1934, Green PolkaDot Box Incorporated has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.


DATE:

August 3, 2012

 

By:

/s/ Rod A. Smith

 

 

 

 

Rod A. Smith

 

 

 

 

Chief Executive Officer

 

 

 

 

 

 

 

 

 

 




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