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lEV-483 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIE LD OPE RA nONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
~~::~EOF: Z~t~st ~~
FILE NO: ~ 7 j'- .s-/
COUNTY OF: c.:..........,.~a-~c!..
DATE OF DEATH: /-/.)-- 7,y
'.'0:
t/13J./3
$
$
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1-. DETERMINATION:
1.
Taxable estate based upan:
The United States Estate Tax Return (Farm 706)
The cammunicatian from the Federal Gavernment
confirming the acceptance af ar changes ta the
Federal Estate Tax Return
Amount af credit far State death taxes (as verified)
Pennsylvania inheritance tax assessed
(excluding any discount and/or interest)
Normal inheritance tax paid to other States or
Territories of the United States (excluding
any discount and/or interest)
Total inheritance tax credits (line item 3 plus line item 4)
Total liability for Pennsylvania estate tax (line item 2
minus line item 5)
~
\-.
--
'~3.$rI3
2.
3.
4.
5.
f>.
NOTE: Complete line items 7 and 8 ONLY when determination
is based an Federal Closing Letter
7.
Amount of Pennsylvania estate tax assessed on determination
dated J .- -":l. ~
Addition (reduction) ta Pennsylva-;;icM.stc(tet;;~ ~ item 6
minus line item 7)
$
8.
Determination prepared by:
Date:
$
--- = -
$
$
-. c...) .-.
-'--
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 from
CREDIT
=
=
=
$
Assessment prepared by:
to the date of payment.
Date:
AGENT FOR THE COMMONWEALTH
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