r1512g112009.htm
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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          1-14225      
 
                                         
HNI Corporation
(Exact name of registrant as specified in its charter)
 
408 East Second Street, P.O. Box 1109, Muscatine, IA 52761-0071    (563) 272-7400
(Address, including zip code, and telephone number, including area code, of registrant's principal executive offices)
 
Preferred Share Purchase Rights
(Title of each class of securities covered by this Form)
 
Common Stock, par value $1.00 per share
(Titles of all other classes of securities for which a duty to file reports under section 13(a) and 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 12g-4(a)(2)   o
  Rule 12h-3(b)(1)(i)   o
  Rule 12h-3(b)(1)(ii)   o
  Rule 15d-6  o
 
Approximate number of holders of record as of the certification on notice date:-0-

Pursuant to the requirements of the Securities Exchange Act of 1934, HNI Corporation has caused this certificiation/notice to be signed on its behalf by the undersigned duly authorized person.
 
 
       
Date:   November 30, 2009
By:
/s/ Steven M. Bradford  
    Vice President, General Counsel and Secretary  
 
 
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.