-----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, Q9eNNyNMrwCFmWF9n80q1ZsRFco9rpyWW3Rm9kcZyee6V8konJMa5VBizJPvDFym /mQtnN8DjO+eiyAZx5R2dw== 0001177103-04-000174.txt : 20040831 0001177103-04-000174.hdr.sgml : 20040831 20040831105041 ACCESSION NUMBER: 0001177103-04-000174 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040827 FILED AS OF DATE: 20040831 DATE AS OF CHANGE: 20040831 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VAN GORDER JAN R CENTRAL INDEX KEY: 0001177116 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24000 FILM NUMBER: 041007054 MAIL ADDRESS: STREET 1: 100 ERIE INSURANCE PL CITY: ERIE STATE: PA ZIP: 16530 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 van466.xml X0202 4 2004-08-27 0 0000922621 ERIE INDEMNITY CO ERIE 0001177116 VAN GORDER JAN R 100 ERIE INSURANCE PLACE ERIE PA 16530 1 1 0 0 Sr Exec VP, Secy & Gen Counsel Class A Common Stock 2004-08-27 4 S 0 20000 49.9000 D 105058.0000 D Class B Common Stock 0.0000 Class A Common Stock 2400.0000 1.0000 D Market value at the date of conversion at the rate of 2,400 shares of Class A for each share of Class B. 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 2004-08-31 -----END PRIVACY-ENHANCED MESSAGE-----