-----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, KrJ6+WNDTTQbrVGbKwzcUPzlj1CdU0z5YfVfowRSlOelu/sGG9X527YTQTW+vdck OWSG8tkCZ/g0TyeiwQAXxw== 0001116502-05-001241.txt : 20050611 0001116502-05-001241.hdr.sgml : 20050611 20050526171400 ACCESSION NUMBER: 0001116502-05-001241 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050525 FILED AS OF DATE: 20050526 DATE AS OF CHANGE: 20050526 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHAFFER EUGENE F CENTRAL INDEX KEY: 0001253418 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 05860832 BUSINESS ADDRESS: STREET 1: 903 EAST UNION ST CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 4 1 shaffer-e_ex.xml X0202 4 2005-05-25 0 0000879635 MID PENN BANCORP INC MBP 0001253418 SHAFFER EUGENE F 903 EAST UNION ST MILLERSBURG PA 17061 1 1 0 0 Chairman of the Issuer & Sub Common Stock 2005-05-25 4 S 0 200 25.15 D 37845.263 I BY TRUST Common Stock 82642 D /s/ Eugene F. Shaffer 2005-05-26 -----END PRIVACY-ENHANCED MESSAGE-----