-----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, DLGm3d/YN+mFTpwr0B9UjJfRMUwIfa95Nk69e0mKI5MKLZiVYk2hfm+e/v9kpVcA i6t1zF8BuJ8/YjcWqw8Wmg== 0001116502-05-002163.txt : 20050922 0001116502-05-002163.hdr.sgml : 20050922 20050922170957 ACCESSION NUMBER: 0001116502-05-002163 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050921 FILED AS OF DATE: 20050922 DATE AS OF CHANGE: 20050922 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DURICA A JAMES CENTRAL INDEX KEY: 0001272238 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 051098630 BUSINESS ADDRESS: STREET 1: 453 LAUREL DRIVE CITY: HERSHEY STATE: PA ZIP: 17033 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 durica-j_ex.xml X0202 4 2005-09-21 0 0000879635 MID PENN BANCORP INC MBP 0001272238 DURICA A JAMES 453 LAUREL LANE HERSHEY PA 17033 1 0 0 0 Common Stock 2005-09-21 5 P 0 500 25.45 D 1500 D /s/ A. James Durica 2005-09-21 -----END PRIVACY-ENHANCED MESSAGE-----