-----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, BXm7gHY/RKDvvBV01jIJrXbVZ1yl/84djqXMP3OeSQ7I/WJtZLKN5kPLwzlhsl2I 78H5hndH1g2jyuHV5ZQoxQ== 0000930413-04-004560.txt : 20040928 0000930413-04-004560.hdr.sgml : 20040928 20040928172046 ACCESSION NUMBER: 0000930413-04-004560 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040924 FILED AS OF DATE: 20040928 DATE AS OF CHANGE: 20040928 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOWERY THEODORE W CENTRAL INDEX KEY: 0001278504 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 041050699 MAIL ADDRESS: STREET 1: 841 WYNNEWOOD ROAD CITY: CAMP HILL STATE: PA ZIP: 17011 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 c33830_ex.xml X0202 4 2004-09-24 0 0000879635 MID PENN BANCORP INC MBP 0001278504 MOWERY THEODORE W 841 WYNNEWOOD ROAD CAMP HILL PA 17011 1 0 0 0 Common Stock 2004-09-24 5 P 0 885 27.55 A 1000 D /s/ T. W. Mowery 2004-09-28 -----END PRIVACY-ENHANCED MESSAGE-----