-----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, QA6IzBVsATEOTjl+wSyiuNay5p94s+RGk+VqiVeJjOGKhabqD7QQ5dYAX/3yCAZS h9oWyYnVRN3mnBGv3B989w== 0001116502-05-001975.txt : 20050822 0001116502-05-001975.hdr.sgml : 20050822 20050822152713 ACCESSION NUMBER: 0001116502-05-001975 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050822 FILED AS OF DATE: 20050822 DATE AS OF CHANGE: 20050822 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: DAKEY ALAN W CENTRAL INDEX KEY: 0001253410 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 051040900 BUSINESS ADDRESS: STREET 1: 156 WAGON RD CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 4 1 dakey-alan_ex.xml X0202 4 2005-08-22 0 0000879635 MID PENN BANCORP INC (MBP) 0001253410 DAKEY ALAN W 156 WAGON RD MILLERSBURG PA 17061 1 1 0 0 President & CEO Common Stock 2005-08-22 5 P 0 0 A 10638.3364 D $2500 in cash value contributed as voluntary contribution. Shares and price to be determined by Plan Administrator. /s/ Alan W. Dakey 2005-08-22 -----END PRIVACY-ENHANCED MESSAGE-----