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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
COUNTY
COUNTY FILE NO: ,;( / - '7}j' ~ //2 /
,
TO: 1-o-?~ If &Ad-// !1
(~l.1::1L;f:~
DATE
ESTATE
Appraised Value of Estate:
Real Estate
Personal Property
$
+ /tf~ ~.qtf,-J/
+ Ij~ 1H-tJ. eHJ
$/4!f /;3tJ.5/
- I~ 1'11. ?tJ
e/~!{ ~ ~;? 9/
a;~. hJ
$ /-2", 63d, '11
$ 1~ 719. 7F?"
17' f53. It,
/
Jointly Held PropenylTransfers
Total Gross Estate
Total Approved Deductions
Clear Value of Estate
less; Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
Amount Taxable @ 6% Rate
tax due
$ ~"Jdt? /7F"
1 3~1. 9'7
/
$/~ ~ qi- 7'3--
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
.. * .. .. * *
A five pereent discount totaling
Inheritance Tax is paid by
.
will be granted if the
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
II) - if - 7'/
$ t"Hf}.tJ-d + $
,
$
= .~, HtJ ' tJ1)
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
TAXPAYER
BALANCE OF PENNSYLVANIA INH~ TA
Assessed by:
See Information on Reverse Side Agent for
------
INFORMATION
To insure proper credit to your account, the name of the estate and file number should be clearly print-
ed on the check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. ~ 2485-708).
To the extent that inheritance tax is paid within three (3) months after the death of the decedent, a
discount of five (5) percent is allowed (72 P.S. ~ 2485-716).
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. ~ 2485-711). Inheritance
Tax on a future interest ;s payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent therea1t'er (72 P.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 days .00017 11 days .00186 21 days .00352
2 days .00034 1 2 days .00203 22 days .00369
3 days .00051 '3 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 1 h days .00250 25 days .00420
6 days .00101 1 days .00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 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 as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. ~ 2485-1001).
Make check or money order payable to:
"Register of Wills. Agent"
Mail to the address listed below: