0001171843-13-002301.txt : 20130529 0001171843-13-002301.hdr.sgml : 20130529 20130529155550 ACCESSION NUMBER: 0001171843-13-002301 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130522 FILED AS OF DATE: 20130529 DATE AS OF CHANGE: 20130529 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PASSAMONTE JANNA L CENTRAL INDEX KEY: 0001578057 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 13878318 MAIL ADDRESS: STREET 1: 49 PHEASANT HILL DRIVE CITY: HALIFAX STATE: PA ZIP: 17032 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 3 1 form3.xml INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES X0206 3 2013-05-22 0 0000879635 MID PENN BANCORP INC MPB 0001578057 PASSAMONTE JANNA L 49 PHEASANT HILL DRIVE HALIFAX PA 17032 0 1 0 0 SVP, Sr Operations Officer Mid Penn Bancorp, Inc. Common Stock 128.0147 D /s/ Janna L. Passamonte 2013-05-28