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I, EV-483 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
TO:
DATE, ~ -:5-/5 - YG
ESTATE OF: AAL C, B--~-
FILE NO: ;;;2- J- t"- 0 /~ 0
COUNTY OF: (' ,I rn. &do-...- . "
DATE OF DEATH: ::;-- k' - 7 Y
/?
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I. DETERMINATION:
1. Taxable estate based upon:
~~he United States Estate Tax Return (Form 706)
The communication from the Federal Government
confi rmi ng 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)
to Normal inheritance tax paid to other States or
Territories of the United States (excluding
any discount and/or interest)
S. Total inheritance tax credits (line item 3 plus line item 4)
I. Total liability for Pennsylvania estate tax (line item 2
minus line item 5)
$
$
..j/S-Io I, l f
$ :;; 8 s,- '-/. ~J
,
o
$
$
~~ !./;-Lj, ~-3
$
0-
NOTE: Complete line items 7 and 8 ONL Y 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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B. ASSESSMENT:
L Pennsylvania Estate Tax reflected on:
line item A (6)
line item A (8) $
2. Less credits:
DATE OF PAYMENT
AMOUNT PAID
INT EREST
($ )
($ )
($ )
CREDIT
=
=
=
"";. Balance of Pennsylvania estate tax due
$
Interest is due at the rate of six (6) percent per annum from
to the date of payment.
Assessment prepared by:
AGENT FOR THE COMMONWEAI.TH
Date:
SEE REVERSE SIDE FOR INSTRUCTIONS