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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPE RA TlONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
TO:
7_/'" - (.,.
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(- I
DATE: _
ESTATE OF:
FILE NO:
COUNTY OF:
DATE OF DEATH:
7.
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A. DETERMINATION:
I. Taxable estate based upan:
The United States Estate Tax Return (Form 706)
The communication from the Federal Government
confirming the acceptance of or changQs to the
Federal Estate Tax Roturn
2. Amount of credit far Stato death taxes <as verilied)
3. Pennsylvania inheritance tax assessed
(excluding any discount and/or interest)
4. Normal inheritance tax paid to other States or
Territories of the United States (excluding
any discount and/or interest)
5. Total inheritance tax credits (line item 3 plu!i line item 4)
6. Total liability for Pennsylvania estate tax (line item 2
minus line item 5)
,
$
$
NOTE: Complete line items 7 and 8 ONL Y when deteminatian
is based an Federal Closing Letter
7.
Amount of Pennsylvania estate tax assessed on determination
dated
Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7)
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8.
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Detennination prepared by(~- #.,.A 1 ,.1
Date: ,,:;., I., //,..
$
$
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B. ASSESSMENT:
1. Pennsylvania Estate Tax reflected on:
line item A (6)
line item A (8)
2. Less credits:
.!lATE OF PAYMENT
CREDIT
AMOUNT PAID
INTEREST
(S I
(S )
IS )
=
=
=
3. Balance of Pennsylvania estate tax due
$
$
Interest is due at the rate of six (6) percent per annum from
to the date of payment.
Assessment prepared by:
AGENT FOR THE COMMONWEAL.TH
Date:
SEE REVERSE SIDE FOR INSTRUCTIONS
To insure proper credit to your account, the name of the estate and file number should be
clearly printed an the check or money order.
--------'--_._--
INSTRUCTIONS
This delermination and assessment is made in accordance with Section 421 and Section 732
of the Inheritance and Estate Tax Act 011961,72 P.S. 2485-.421, 732.
The estate tax imposed by Section 421 is due at Ihe date of the decedent's death but shall
not become delinquent until the expiration of eightccn (18) months after decedent's death provided
Ihat any estate tax occosioned by 0 final change in the Federal return or of the tax due thereon
sholl not become delinquent until the expirolion of one (1) month after the person liable to pay
Ihe lox receiyes final notice of the increaso. Culculole inlerest from the delinquent date shown
on Ihe face ollhis lorm to the date of payment using the following interest tab'e:
-------- --------.------ --- --- ----- -- --- --- -- -- ---- - -- - -- --- --- ---- --- -- -- - -- --- ---
1 monlh .005 4 month s .020 7 month s .035 10 months .050
2 months .010 5 months .025 8 monlhs .040 11 months .055
3 monlhs .ms 6 monlhs .030 9 months .045 12 months .060
1 day .00017 11 days .00186 21 days .U0352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 day s .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 day s .00437
7 days .00118 17 day s .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 7!i days .00488
10 days .00169 20 days .00335 30 day s .00500
.----------------------------------------------------------------------------------
Any parly in inlerest, including Ihe Commonwealth and the personal represenlalive, nol
satisfied with the assessment may object thereto within sixty (60) days alter receipl 01 this
notice as prayided by Seclion 1001 of the Inheritance and Estale Tax Act of 1961 (72 P.S.
!i 2485-1001)
Make check or money order payable to:
"Register of Wills, Agent"
Moil to the address listed below: