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REV-483 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASS~SSMENT OF PENNSYLVANIA
ESTATE TAX
DATE:
ESTATE OF:
FILE NO:
COUNTY OF:
DATE OF DEATH:
TO:
/
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A. DETERMINATION:
1. Taxable estate based upon:
The United States Estate Tax Return (Form 706)
The communication from the Federa.1 Govemment
confirming the acceptance of or changes to the
Federal Estate Tax Return
2. Amount of credit for State death taxes (as verified)
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 di scount and/or interest)
5. Total inheritance tax credits (line item 3 plus line item 4)
6. Total liability for Pennsylvania estate tax (line item 2
minus line item 5)
NOTE: Complete line items 7 and 8 ONLY when determination
is based on 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)
8.
Determination prepared by:
Date:
$
$
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$ I
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B. ASSESSMENT:
1. Pennsylvania Estate Tax reflected on:
line item A (6)
line item A (8)
2. Less credits:
DATE OF PAYMENT
AMOUNT PAID
INTEREST
($ )
($ )
($ )
3. Balance of Pennsylvania estate tax due
Interest is due at the rate of six (6) percent per annum fram
Assessment prepared by:
Date:
$
CREDIT
=
=
=
$
to the date of payment.
AGENT FOR THE COMMONWEALTH
SEE REVERSE SIDE FOR INSTRUCTIONS