-----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, POc/aWsKrjDd7+rjQp4VHG7duNmznNcn782Qu2JmjO+6XMJPf/8J4tBqiAH4kB7h XM2y/lHYwSX7oTZGUY6VUA== 0001116502-04-002777.txt : 20041122 0001116502-04-002777.hdr.sgml : 20041122 20041122113549 ACCESSION NUMBER: 0001116502-04-002777 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041122 FILED AS OF DATE: 20041122 DATE AS OF CHANGE: 20041122 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WILLIAMS ERIC S CENTRAL INDEX KEY: 0001253422 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 041159690 BUSINESS ADDRESS: STREET 1: 5 GRAYSTONE MANOR DR CITY: CAMP HILL STATE: PA ZIP: 17011 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 williams-eric_ex.xml X0202 4 2004-11-22 0 0000879635 MID PENN BANCORP INC (MBP) 0001253422 WILLIAMS ERIC S 5 GRAYSTONE MANOR DR CAMP HILL PA 17011 0 1 0 0 Ex. VP & Chief Lending Officer Common Stock 2004-11-22 5 P 0 0 A 198.069 D $600 in cash value contributed as voluntary contribution. Shares and Price to be determined by Plan Administrator. Eric S. Williams 2004-11-22 -----END PRIVACY-ENHANCED MESSAGE-----