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Ill!V.483 (6.16)
COIIMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPE RA TIONS
INIIERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
II- .>1-":<
DATE: II - ..'" - cl'O
ESTATE OF:---1I",'/~ A-: A'r 6,;(
FILE NO: ~ 1- J'tJ - .1.0.3
COUNTY OF: C-w>tJ,;n/PAI..I
DATE OF DEATH: /..:z - .1.3' - 79
TO:__
-----------...----- ---------- ------------- ----- ------------------ ---- -- - -- ---------- --- ----
/. DET ERMINA TION:
1. Toxable astate bosod upon:
The United States Estole Tox Return (Form 706)
~ The communication from the Federal Government
confirming the acceptance of or changes to the
Federal Estote Tox Return
2. Amounl of credit lor Stote death toxes (as verified)
3. Pennsylvonia inheritance tax assessed
(excluding ony discount ond/ol intelest)
4. Hormal inheritance tax paid to other States or
Territories 01 the United St.tes (excludlns
ony discount ond/or interest)
5. Totol inheritance lax crodits (line item 3 plus line item 4)
6. Tatolliability lor Pennsylvanio estote tox (line item 2
minus line item 5)
NOTE: Complete line items 7 ond 8 ONL Y when determinotion
is bosed on Federol Closlns Letter
7.
Amount of Pennsylvania estate tax assessed on determination
doted ?~..~ li'C!
Addition (reduction) to Pcnnsylvonia estate tox (line item 6
minus line item 7)
8.
S - o-
S -0 -
$ O-
S -0 -
S -o-
S - "'-
$
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$
DATE OF PAYMENT AMOUNT PAID INTEREST CREDIT
------ ($ ) "
--
($ ) "
($ ) "
3. Balance of Pennsylvania estate tax due $
Interest is due at the rote of six (6) pevccnt per annum from
Assessment prepared by:
Dote:
to the dot. of payment.
AOENT FOR THE COMMONWEAl.TH
SEE REVERSE SIDE FOR INSTRUCTIONS
INSTRUCTIONS
To insure proper credit to your account, the nome of the estate and fi Ie number should be
clearly printed on the check or money order.
This determination and assessment is mode in accordance with Section 421 and Section 732
of the Inheri tonce and Estate T ox Act of 1961, 72 P. S. 2485-421, 732.
The estate tax imposed by Section 421 is due at the dote of the decedent's death but sholl
not become delinquent until the expiration of eighteen (18) months ofter decedent's death provided
that ony estate fox occasioned by 0 final change in the Federal return or of the tax due thereon
sholl not become delinquent until the expiration of one (1) month afler Ihe person liable to pay
the tax receives final notice of the increese. Calculate interest from the delinquent dole shown
on the foce of this form to the dote of payment using the following interest tab' e:
----------------------------------------------------------------------------------
1 trOnth .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .015 6 months .030 9 months .045 12 months .060
1 day .00017 11 doy s .00186 21 days .U0352
2 day s .00034 12 days .00203 22 day s .00369
3 days .00051 13 days .00220 23 days .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 79 days .00488
10 days .00169 20 days .00335 30 days .00500
.----------------------------------------------------------------------------------
Any party in interest, including the Commonwealth and the personal representative, not
satisfied with the assessment may object thereto within sixty (60) days after receipt of this
notice os provided by Section 1001 of the Inheritance and Estate 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: