0000899243-17-024559.txt : 20171023 0000899243-17-024559.hdr.sgml : 20171023 20171023160117 ACCESSION NUMBER: 0000899243-17-024559 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121214 FILED AS OF DATE: 20171023 DATE AS OF CHANGE: 20171023 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Burkholder Eugene N CENTRAL INDEX KEY: 0001542390 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38084 FILM NUMBER: 171149049 MAIL ADDRESS: STREET 1: 12730 US HIGHWAY 20A CITY: WAUSEON STATE: OH ZIP: 43567 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FARMERS & MERCHANTS BANCORP INC CENTRAL INDEX KEY: 0000792966 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 341469491 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 307-11 N DEFIANCE ST CITY: ARCHBOLD STATE: OH ZIP: 43502 BUSINESS PHONE: 4194462501 MAIL ADDRESS: STREET 1: 307-11 NORTH DEFIANCE ST CITY: ARCHBOLD STATE: OH ZIP: 43502 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-12-14 0 0000792966 FARMERS & MERCHANTS BANCORP INC FMAO 0001542390 Burkholder Eugene N 12730 US HIGHWAY 20A WAUSEON OH 43567 1 0 0 0 Common stock 2012-12-14 4 G 0 2500 0.00 D 5240 I By Trust Common stock 2012-12-14 4 G 0 2500 0.00 A 2500 I by spouse trust Common stock 2013-05-06 4 P 0 717 21.90 A 5957 I By Trust Common stock 2013-05-06 4 P 0 716 21.90 A 3216 I by spouse trust /s/ Eugene N. Burkholder 2017-07-10