-----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, MLw1/wFxxHRmsgqQ+pwpEf9ryXd+0nsoFcGbpNZ4U9J96kTBnlBBFZsBblxR0k6k gvoEZ8kqEvp061+u4YNsdg== 0000930413-04-004018.txt : 20040826 0000930413-04-004018.hdr.sgml : 20040826 20040826172230 ACCESSION NUMBER: 0000930413-04-004018 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040823 FILED AS OF DATE: 20040826 DATE AS OF CHANGE: 20040826 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: 04999675 BUSINESS ADDRESS: STREET 1: 156 WAGON RD CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 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 c33522_ex.xml X0202 4 2004-08-23 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 2004-08-23 5 P 0 0 A 9947.109 D $2500 in cash value contributed as voluntary contribution. Shares and price to be determined by Plan Administrator. /s/ Alan W. Dakey 2004-08-23 -----END PRIVACY-ENHANCED MESSAGE-----