0001354488-11-001383.txt : 20110506 0001354488-11-001383.hdr.sgml : 20110506 20110506152641 ACCESSION NUMBER: 0001354488-11-001383 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110505 FILED AS OF DATE: 20110506 DATE AS OF CHANGE: 20110506 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Monteverde Terrence M. CENTRAL INDEX KEY: 0001485628 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 11819131 MAIL ADDRESS: STREET 1: 535 W. HIGH ST CITY: HUMMELSTOWN STATE: PA ZIP: 17036 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 issuerdirect_section16.xml PRIMARY DOCUMENT X0303 4 2011-05-05 0 0000879635 MID PENN BANCORP INC MPB 0001485628 Monteverde Terrence M. 535 W. HIGH ST HUMMELSTOWN PA 17036 1 SVP, CHIEF LENDING OFFICER Common Stock 2011-05-05 4 P 0 1370 9.46 A 1870 D Common Stock 1375 D Common Stock 1000 D Account name is Beth A. Monteverde JTWROS Terrence Monteverde Account name is Terrence M. Monteverde and Jan L. Monteverde JT Purchase for the IRA Account for Terrence Monteverde. /s/ Terrence M. Monteverde 2011-05-06