-----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, LeX8v81yhbp8lVPLOWvSd85qqLIziWknbSGyLOrBYMVS29EJoDf8zJAiDb6BIIh6 VP82ctcIDwzuDdmS7/MtLA== 0001177103-03-000186.txt : 20031023 0001177103-03-000186.hdr.sgml : 20031023 20031023112736 ACCESSION NUMBER: 0001177103-03-000186 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031021 FILED AS OF DATE: 20031023 ISSUER: 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 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: OWNER DATA: COMPANY CONFORMED NAME: HAGEN SUSAN HIRT CENTRAL INDEX KEY: 0001100591 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24000 FILM NUMBER: 03953372 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 1 hag262.xml X0201 4 2003-10-21 0 0000922621 ERIE INDEMNITY CO ERIE 0001100591 HAGEN SUSAN HIRT 5727 GRUBB ROAD ERIE PA 16506 1 0 1 0 Class A Common Stock 6658800.0000 D Class A Common Stock 10092900.0000 I Ltd Partner,Hagen Family Ltd Partnership Directors' Deferred Compensation Phantom Units 0.0000 2003-10-21 4 J 0 5.937 0 A Class A Common Stock 5.9370 752.3981 D Class B Common Stock 0.0000 Class A Common Stock 28800.0000 12.0000 D Class B Common Stock 0.0000 Class A Common Stock 2808000.0000 1170.0000 I Beneficiary & Trustee, Trust Class B Common Stock 0.0000 Class A Common Stock 2808000.0000 1170.0000 I Contingency Beneficiary & Trustee, Trust Class B Common Stock 0.0000 Class A Common Stock 2400.0000 1.0000 I Ltd Partner,Hagen Family Ltd Partnership 6,658,500 of these shares are held in a Grantor and Beneficiary, Revocable Trust Reporting person does not have sole or shared investment or voting authority Acquired under dividend reinvestment for Directors' Deferred Compensation Plan The shares subject to this reporting are phantom Share Credits which are periodically credited to the accounts of certain Directors of Erie Indemnity Company pursuant to its Outside Directors Stock Plan. These Credit Shares are actually paid to the reporting individual in shares of Erie Indemnity Company Class A Common Stock when their service as a Director of Erie Indemnity Company ends. There is no exercisable date for these securities. The shares subject to this reporting are phantom Share Credits which are periodically credited to the accounts of certain Directors of Erie Indemnity Company pursuant to its Outside Directors Stock Plan. These Credit Shares are actually paid to the reporting individual in shares of Erie Indemnity Company Class A Common Stock when their service as a Director of Erie Indemnity Company ends. There is no expiration date for these securities. Market value at the date of conversion at the rate of 2,400 shares of Class A for each share of Class B. By: Linda A. Etter, Power of Attorney 2003-10-23 -----END PRIVACY-ENHANCED MESSAGE-----