-----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, KyHElMeVZelsbl6ZwoUvS7jJHlxIdhmVbG460ohtpJME8FhDSugipe5Fc8+mc1T/ /cI5rLMdTsftmv64xt8Cug== 0001177103-04-000116.txt : 20040510 0001177103-04-000116.hdr.sgml : 20040510 20040510145402 ACCESSION NUMBER: 0001177103-04-000116 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040510 FILED AS OF DATE: 20040510 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LILLY CLAUDE C III CENTRAL INDEX KEY: 0001177125 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24000 FILM NUMBER: 04792546 MAIL ADDRESS: STREET 1: 9201 UNIVERSITY CITY BLVD. CITY: CHARLOTTE STATE: NC ZIP: 28223 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 4 1 lil408.xml X0202 4 2004-05-10 0 0000922621 ERIE INDEMNITY CO ERIE 0001177125 LILLY CLAUDE C III UNIVERSITY OF NORTH CAROLINA, CHARLOTTE 9201 UNIVERSITY CITY BLVD. CHARLOTTE NC 28223 1 0 0 0 Class A Common Stock 2004-05-10 4 P 0 100 44.9800 A 600.0000 D Directors' Deferred Compensation Phantom Units 0.0000 Class A Common Stock 1266.0771 1266.0771 D 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. By: Linda A. Etter, Power of Attorney 2004-05-10 -----END PRIVACY-ENHANCED MESSAGE-----