-----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, IVzwzWWyODVIzDBO668IwSofjVCdmsM4RBWCh7SVzdsrrTC4enZL5UDJjXDqrDQM zxrnTxgG2y4vTLPFblnbcw== 0001177103-02-000015.txt : 20020924 0001177103-02-000015.hdr.sgml : 20020924 20020924161447 ACCESSION NUMBER: 0001177103-02-000015 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020924 FILED AS OF DATE: 20020924 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ERIE INDEMNITY CO CENTRAL INDEX KEY: 0000922621 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 250466020 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-24000 FILM NUMBER: 02771177 BUSINESS ADDRESS: STREET 1: 100 ERIE INSURANCE PL CITY: ERIE STATE: PA ZIP: 16530 BUSINESS PHONE: 8148702000 MAIL ADDRESS: STREET 1: 100 ERIE INSURANCE PLACE CITY: ERIE STATE: PA ZIP: 16530 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: HAGEN SUSAN HIRT CENTRAL INDEX KEY: 0001100591 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: C/O ROGER W RICHARDS STREET 2: 100 STATE STREET - STE 440 CITY: ERIE STATE: PA ZIP: 16507-1456 BUSINESS PHONE: 8144550370 MAIL ADDRESS: STREET 1: C/O ROGER W RICHARDS STREET 2: 100 STATE STREET - STE 440 CITY: ERIE STATE: PA ZIP: 16507-1456 4/A 1 hag19.htm SEC Form 4/A
FORM 4

[ ] Check this box if no longer
subject to Section 16. Form 4 or Form
5 obligations may continue.
See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C.  20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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Expires: January 31, 2005
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hours per response. . . . . 0.5
1. Name and Address of Reporting Person*
Hagen, Susan     Hirt

(Last)                      (First)                      (Middle)
5727 Grubb Road


(Street)
Erie, PA     16506

(City)                      (State)                      (Zip)

2. Issuer Name and Ticker
    or Trading Symbol

Erie Indemnity Company   ERIE

3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)
4. Statement for
    (Month/Year)

    September 24, 2002


5. If Amendment,
    Date of Original
    (Month/Year)
    09/10/2002
6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

           X          Director              X          10% Owner
                        Officer                             Other

Officer/Other
Description                              

7. Individual or Joint/Group
    Filing (Check Applicable Line)

X   Individual Filing
      Joint/Group Filing
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security
    (Instr. 3)

2. Transaction Date
    (Month/Day/Year)
3. Transaction
    Code
    and
    Voluntary
    Code
    (Instr. 8)



Code  |  V    
4. Securities Acquired (A) or Disposed (D) Of
    (Instr. 3, 4, and 5)





        Amount      |         A/D         |         Price          
5. Amount of
    Securities
    Beneficially
    Owned at
    End ofMonth

    (Instr. 3 and 4)
6. Owner-
    ship
    Form:
    Direct(D)
    or
    Indirect (I)

    (Instr. 4)
7. Nature of
     Indirect
     Beneficial
     Ownership

    (Instr. 4)
Class A Common Stock


6,658,800.0000 (1)
D (2)

Class A Common Stock


276,000.0000
I
Grantor, Charitable Lead Annuity Trust (3)
Class A Common Stock


10,092,900.0000
I
Ltd Partner,Hagen Family Ltd Partnership (4)







Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).

(over)
SEC 1474 (3-99)

Hagen, Susan Hirt - September 2002
Form 4 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
    (Instr. 3)
2. Conver-
    sion or
    Exercise
    Price of
    Deri-
    vative
    Security
3. Transaction
    Date

    (Month/
    Day/
    Year)
4. Transaction
    Code
    and
    Voluntary (V)
    Code
    (Instr.8)



Code | V    
5. Number of Derivative
    Securities Acquired (A)
    or Disposed (D) Of

    (Instr. 3,4 and 5)
6. Date Exercisable(DE) and
    Expiration Date(ED)
    (Month/Day/Year)






  (DE)     |     (ED)  
7. Title and Amount of
    Underlying Securities
    (Instr. 3 and 4)
8. Price
    of
    Derivative
    Security
    (Instr.5)
9. Number of
    Derivative
    Securities
    Beneficially
    Owned
    at End of
    Month
    (Instr.4)
10.
Owner-
ship
Form of
Deriv-
ative
Security:
Direct
(D)
or
Indirect
(I)
11. Nature of
      Indirect
      Beneficial
      Ownership
      (Instr.4)
Directors' Deferred Compensation Phantom Units
$0.0000 09/09/2002
J (5) |     
    (A) 143.2166
Class A Common Stock - 143.2166
143.2166
D

Class B Common Stock
Current market



Class A Common Stock - 28,800.0000
12.0000
D (6)

Class B Common Stock
Current market



Class A Common Stock - 2,808,000.0000
1,170.0000
I
Beneficiary & Trustee, Trust
Class B Common Stock
Current market



Class A Common Stock - 2,808,000.0000
1,170.0000
I
Contingency Beneficiary & Trustee, Trust
Class B Common Stock
Current market



Class A Common Stock - 2,400.0000
1.0000
I
Ltd Partner,Hagen Family Ltd Partnership (4)











Explanation of Responses :


** Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
        See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note:   File three copies of this Form, one of which must be manually signed. If space is insufficient,
            See Instruction 6 for procedure.

Potential persons who are to respond to the collection of information contained in this form are not
required to respond unless the form displays a currently valid OMB number.
/s/ Susan Hirt Hagen
________________________________            09-24-2002    
** Signature of Reporting Person                         Date




Page 2
SEC 1474 (3-99)

Hagen, Susan Hirt - September 2002
Form 4 (continued)
FOOTNOTE Descriptions for Erie Indemnity Company ERIE

Form 4 - September 2002

Susan Hirt Hagen
5727 Grubb Road

Erie, PA 16506

Explanation of responses:

(1)   6,658,500 of these shares are held in a Grantor and Beneficiary, Revocable Trust
(2)   Inadvertently listed 5,100 shares held by spouse.
(3)   The reporting person disclaims beneficial ownership of these shares
(4)   Reporting person does not have sole or shared investment or voting authority
(5)   Acquired under Directors' Compensation Plan
(6)   Inadvertently listed 3 shares held by spouse.
Page 3
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