-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, FZnC8xJnFPWLKc8tjfnSCU83lusxn4G+23kOf+ZObZq0Dmmt82KTziU8NG22wdvA grik8YMBLdw7vIzK9vBLPA== 0001005150-03-001638.txt : 20031021 0001005150-03-001638.hdr.sgml : 20031021 20031021164714 ACCESSION NUMBER: 0001005150-03-001638 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031020 FILED AS OF DATE: 20031021 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: IN TRUST FOR BENEFIT OF MICHELLE L SHAFFER CENTRAL INDEX KEY: 0001262076 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 03950150 BUSINESS ADDRESS: STREET 1: 349 UNION ST CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MID PENN BANCORP INC CENTRAL INDEX KEY: 0000879635 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 251666413 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 349 UNION ST CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 MAIL ADDRESS: STREET 1: 349 UNION STREET STREET 2: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 4 1 e3628ms_ex.xml X0201 4 2003-10-20 0 0000879635 MID PENN BANCORP INC MBP 0001262076 IN TRUST FOR BENEFIT OF MICHELLE L SHAFFER 903 EAST UNION STREET MILLERSBURG PA 17061 0 0 0 1 TRUST WITH INSIDER TRUSTEE Common Stock 2003-10-20 4 S 0 200 23.50 D 8719.395 D Eugene F. Shaffer, Trustee 2003-10-21 -----END PRIVACY-ENHANCED MESSAGE-----