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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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DATE OF DEATH
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COUNTY FILE NO:
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DATE
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ESTATE
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FILE NO.
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COUNTY
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Appraised Volue of Estato:
Real Estate
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$
Personal Property
+
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Jointly Held PropertylTransfers
+
Total Gross Estate
$
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Total Approved Deductions
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Clear Valuo of Estate
$' ----.----.-----
Less: Approved Charitable Exemptions
Clear Valuo of Estate subjoct to Tax
$
Amount Taxabla @ 6% Rate
$
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tax du.'./:',Jt-l[~'-I(/ [...<<-J:-'l.L'V/
Amount Taxablo @ 15% Rato
tax due i ,/ 1 _/
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TOTAL PENNSYLVANIA INHERITANCE TAfOUE;;11 ..(,Y.A' (//-' ' %'",
,.. ,.. ,.. 'It '/I' . A five percent discount totaling $
will ba granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAlO
DISCOUNT
INTEREST
TAX CREDIT
$
+
$
s
=
$
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=
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=
Interesl accrues 8t 1he rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from . _ .___--'"
to date of payment. Interest due if paid bV is,., /' ~'}i 1)/
BALANCE OF PENNSYLVANIA INHERITANCE TAXOy{;'I.j.rt$<~ ,c;,~,,;C ,o. ,-"c)::::;;<./)
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Assessed by: '-.: If" (
Agent fonhe Common ahh .
See Information on Reverse Side . _'!.) i/ . ;f--"
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INFORMATION
To insuro prapor credit to your [lccount, thu nmne of thu 051nlo and Ille numbor should be clomly print-
ed on the check or money order.
This assessment is mado in accordanco with Section 70B of the Inheritance and Estate Tax Act of
1961 (72 P.S. 9 2485.7081.
To the 8;t(fonl that inheritance lax is paid wi/hin three (31 months after tho death or the decedent, a
discount of five (51 percent is allowod (72 P.S, 9 2485.7161.
Inheritance Tax, other than tax on a future interest. is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P,S, S 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. S 2485.712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
------------ --- ----- - - -------- - -- - -- -- - - ---- --- - - - -- - --- --.~----- -- -- - - - -- --
1 month .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 davs .00017 11 days .00185 21 davs .00352
2 days .00034 12 davs .00203 22 days .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 davs .00420
6 days .00101 16 d.ys .00267 26 davs ,00437
7 davs .0011e 17 days .00284 27 davs ,00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 davs .00318 29 davs .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 (GO) days after receipt of this Notice as provided by Section
1001 of tho Inheritance and Estate Tax Act of 1961 (72 P.S. 9 2485.10011.
Make check or money order pavable to:
"Register of Wills, Agent"
Mail to the address listed below: