0001171843-13-004773.txt : 20131122 0001171843-13-004773.hdr.sgml : 20131122 20131122125008 ACCESSION NUMBER: 0001171843-13-004773 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20131121 FILED AS OF DATE: 20131122 DATE AS OF CHANGE: 20131122 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: LAUDENSLAGER KEVIN W CENTRAL INDEX KEY: 0001253420 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 131237561 4 1 form4.xml STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES X0306 4 2013-11-21 0000879635 MID PENN BANCORP INC MPB 0001253420 LAUDENSLAGER KEVIN W 2518 NORTH 2ND STREET HARRISBURG PA 17110 0 1 0 0 Vice President and Treasurer Mid Penn Bancorp, Inc. Common Stock 2013-11-21 4 J 0 2208.5984 A 2208.5984 I IRA Mid Penn Bancorp, Inc. Common Stock 200 I IRA Mid Penn Bancorp, Inc. Common Stock 2201.6868 D Shares distributed from employee's account pursuant to dissolution of Employee Stock Ownership Plan. Shares were acquired over various dates. Balance includes shares acquired through Employee Stock Purchase Plan and Dividend Reinvestment Plan /s/ Kevin W. Laudenslager 2013-11-22