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INPQRMA1'ION
To Ineute prop" clod It to VOUI oCecunl, the, nri!liO (If, ,he oe\ata ond file numbor ehould be clearly Pllnt.'
ed on Ihe check or menev order, '
ThiS auenmanl Ie mede In accordonce with 8ecllon 708 of the Inherltenea and Eclate Tex Acto!
1\181 In P,8. 9 2488.7081, '
To the extenl that Inherltaneo tax II paid wllhln throe (3) monthl of tor tha dealh of Iho deeodanl, e
dlecounl cl flvo (81 percent Ie ollowad (12 P,B. 6 2485.115),
Inhalllance Tax, other than lOX on 0 futu,. Interell. Ie due pt Iho dota cf tho deaedent's death and bocomOl
delinquent at, Iho 'explrallon 0,1 nino' (91 montlls aller the decedent's deoth 172 p,8. 9 2485,711), Inheritance
Tex,Qn . future Intareat lepoyobl.' wllhln three (31 months ofter the transfer tnkoo effcct In pcuanlcn, and'
enloyment and Ie delinquent thereaftcl (72 P.B. 9 2488'" 2). Colculato IntorOlI frem Iho dellnquanrdoto ehown
on the feee of thle 101m 10 the date 01 eotuel peyment ullng Ihe lollowlng Inter"t table:
. . . .
~__.......__""_"..._..._.._-....._.,- ..._.....~_...__ ...'__'" ..ol.i._... __...~....'__"'-O"'''' ......-... -..- -------- ....... --.... -.... -... -'-
1 month .008 4 monlhe .020 7 monthl .oas 10 monthe ,060
2 mOhthe .0,0 5 month. .028 B montl11 ,040 11 monlhe .068
3 monthe ,016 B monthe .030 9,monlho ,04. 12 n\onthe ',000
ldtvO ,000\7 11 daye ,00IBB 21 daye .003B2
2 dove .00034 12 dave .00203 22 dave ,00300
3 dove .00061 13 daye .00220 23 dove ,003\1B
4 deY' ,00088 14daH ,00237 24 deye ,00403
edeVe .00088 1 ~ daVI ,00280 28 doye .09420
~ diwo .00101 1 davs ,00287 2sdavs ,09497,
,dm .00110 17 daye ,00284 2'/ dove .00484 '
II doye .09136 18 dove .00:101 28 dove .00471
o dove .00152 19 dOYo ,00318 20 dayo .00488
10 dove ,00180, 20 dpyo ,OOa36 30 daye ,,00600
... - ...._"'" ...,.----- .....---....-...,........ -~....... --... - -.......--...- -'- ~,-~'" --... --...---.... - - -.... ...-".......-..-- -.--~....~
Arw POlty In InwoOl, ,Ino.ludlnll Iha Commonwaalth and ,Iho parionol repr.aenlallve,n9,! aoUefled Wllh
the auoaamenl mey, cbleel thereto wllhln olxlV (801 dova ,allor locelpt 01 tllla ,Nctlco 01 plovlded bV lIectlOn
'00' of the InherltriMllll"d Eetote TQx Acl of 10ai (72 P,S. ti ~4a6,'001l! "
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Make o~eok otmo"~y' ortJer payable to:
"Reg1ete,r 01 Wille. Agent"
MelitO the addree811eted belOW:
INS'TRUCTIOHS
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ASSElSl
TJ...!'.] OF ASSBT ~ Indlcata whothor tho'auat I,raal OItota, pOllonal propolty, lIan,f., Hialntly.ownad.
DESCRIPTIO ~ \.I'tallouot' owned ,alaly by the decodant 01 awned lalntly with onother pOr'Y or portio,' 0' lenonh In
common or a, olnt,tonan" with right of ,urvlvollhlp at tho tl!"o of death. Includo, tho dqoodant' percontoge of owner,hlp,
tho noma (,) and ralotlanlhlj> 10 tho doeodant of tha',urvlvln~lolnt owno" and tho a,tlmatad mOlkat valuo aftha decadant',
Intar..t 0' of the dote of doath. Include Intanglbla pal,onol proparty tltlad In tho noma of tho dacadant but poyable et death
to anothor party orloltlU Including but not Ilmltad toP.O,P. U,S. SavlnU' Bond, and tentotlva tru,t aceoonll. \.I,t any
property tran,lerra by the dace dent within twe yaar' 01 daath tal which he/'ha did not raealvavaluable and adaquate
can,lderotlon.
DOlerlbe aUrool o,tata locatod In Pann,ylvonla by lot ond block numbol, 'lIoot addlo", nomber of aCla,' ond Include 0
genoral dncllptlon of tho land and buildings, Al,o, Inoluda the book and pogo numbar In which tho dood I' locordad and tho
ekact title n Indicated on Ihe d..d.
PEBTS & DBp,UCTIONS ~ Un,atlsfled Ilabllltlulncurred by tho decedant pllor to hl,/hol death 010 deductlblo agoln,t
111,7her taxab o,e,tate, In addition to dob" IncYI/od by tho docodont, othollto!",' 010 claimable Including tho co,tof
admlnl,,,atlon, / ot,tolney I.." '1lduclary fo.., lonerol and burlo,lo.ponlO"I,ncludl ng tho oo,t of 0 burlaUot, ,tomb'lono 01
gravo malker. 1.1,1 the dote on which oach dobl woo Incurlld and/or paldond. tho namo' of each pay... Provide 0 b,lel
e.planatlon of the nalUte of oach debl clalmod' and tho alllaunt baing e;lalmod.
Evidence to IUpport the decedonl', 01 Iho ..toto'. Ila~lllty for tho deb" bolng .1(lIIIIed ,hould be artoch,d to thl, IOtU/O.
A family o,~empllan !"cy bo claimed by 0 ,poulO,ol a docadontwho diad domlcllod ,In Ponnlylvanla. .II tholl l,ne'POUlO,
01 If thatpoU'o hot lorloltad hl,/hor Ilghh, thon any child of tho doeodantwhol, 0 membor of tho lama houlOhold con claim
tho a.amptlon. In tho ,vent thero I,no ouch ,pOUt. 0,1 child, tho o..mptlon ,can ba clalmad by 0 paront or parontl who ore
memb." 01 the 10m' houiOhold 0' the decedont.
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INFORMATIOlo\
rLACII rpR PI~I.HG";,The leturn II to bellied In duplicate with the Regl,tol of Willi of tho countYiwh.,e,ntht decedent
r"ldea,
TIM!! PQUILIHc)_,~The return I, duo nlnt ntonth,aftor the docodent', d"ath, unlou on oxl'n,lonlor IIl1n~ hal boon app'l1.d
~rUn'iidby tho Secretary 01 Ro.,en,oe wlt"ln the ~Ino'month porlod. .
~AIWRIPO PI~. R.TURli ~ Section 791 01 the 1961 Statoto plovld.. that" , .'\anyp.,~on who willfully lall~to lile 0
rltu,m ot othor repolt t.qul"~ ~j him oho I b. pat.onally liable, . .10 a ponalty of 25% of tho to. ul\lmaloly lound to b.
~u. or $1,000 whlchover Is tho 10.. to bo ,rocovoted by thoDopartm~nt ,of Revenue al deht,' elllke amount ate recoverable
by law," .
J:!.2;lll. Felli paid to on ,e,tote IOprelel'ltatlve; l'Iomely. (ll'leweoutal or admll'llltlalor, far ,er"loel perlormed In ad-
mlnletO/lnll on "tole I' reportable lor Pennsylvania Income tow pUlpo,ell Tnl, towable Income \lem snoud be reporled on
form PA.40.1ndlvlduallncoll1ll tow Retuln,
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