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I
REV-463 (6-78)
j COr.v.lONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
. - BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND.ASSESSMENT OF PENNSYLVANIA
- ESTATE TAX
-
/0 -/bh- j
TO:
DATE:
ESTATE OF:
. FILENO:
COUNTY OF: -
DATE OF DEATH:
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A. DETE~MINATION:
1. Taxable estate based 'upan:' ' "
~~d States Estate Tax Return (Farm 706) :
~ communication from the ,Federal Government,
confirming the acceptance of or. changes to the..
Federal Estate Tax Return
2. Amount of credit for State death tax~s (as'verified)
3. ~en~~ylvanici- i"nheritonce 'tax Q'ss'essed
" (excluding any discount ~nd/or interest)
4. . Normal inheritance tax paid to other States or
, Territories of the United States (excluding
,..j any di scount and! or interest)
,',5. "',Tatal inherita~ce tax credits (line item 3 plus line item-4) ,
: 6..,,'- :.Totol liabifity for. Pennsylvania estate tax (line item 2.
minus I.ine item 5)
H'
$
f/3.~i S~
$-'J/~ ;2)JR. 'IG.
$. -0-:-
~.-- .
" .
$
--- 0 .-- ....
$
$
,~g3J/53.
...:;..... e:>-
,j..
, ,'. '",'NOTE: Complete line items 7 and 8 ONLY when determination
"';.'-',';,- is based on Federal Closing Letter. .
"",--" ,. "
7~'" Amount of Penn-sylvania estate tax os~essed on determination
",: 'dated "', 10 -/0 - 77 '
" ,,8., ' .-, Addition (reduct,ion) ta Pennsylvania estate tax (line item 6
minus line item 7)
$
-.-: 0 -.
Detemination prepared by:
Date:
_ c)
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B. ASSESSMENT: , '"
1. Pennsylvania Estate-'Tax i'l~f1ecte'd-on::'
I ine item A (6)
I ine item A (8)
2. Less credits:
DATE OF PAYMENT
$
AMOUNT PAID, INT EREST
- ($)
($ )
($ )
, CREDIT
=
=
3a 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 COMMONWEAL. TH
Date:
SEE REVERSE SIDE FOR INSTRUCTIONS
\
\
INSTRUCTIONS
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To insure proper credit to your account, the nome of the estate and file number should be
.deorly printed on the check or money order.
This determination and assessment is mode in accordance with Section 421 and Section 732
of the Inheritance and Estate Tax Act of 1961, 72 P.S. 2485-421, 732.
Th.e estate tax imposed by Section 42] is due at the dote of the decedent's death but shall
not become delinquent until the expiration of eighteen (]8) months after decedent's death provided
that any estate tax occasioned by a final change in the Federal return or of the tax due thereon
sholl not become delinquent until the expiration of one (1) month after the person liable to pay
the tax receives final notice of the increase. Calculate interest from the delinquent date shown
On the face of this form to the date of payment using the following interest table:
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] month .005 4 month s .020 7 months .035 ]0 months .050
2 months .010 5 months .025 8 months .040 ] 1 months .055
3 months ,()]S 6 months .030 9 months .045 ]2 months .060
1 day .00017 11 days .00]86 21 days .00352
2 day s .00034 12 days .00203 22 days .00369
3 days .0005] ]3 days .00220 23 day s .00386
4 days .00068 ]4 days .00237 24 days .110403
5 days .00085 ] 5 days .00250 25 days .00420
6 days .00]01 16 days .00267 26 days .00437
7 days .00118 ]7 days .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 ]9 days .00318 29 days .00488
10 days .0016.9 20 days .00335 30 days .00500
I ,___ ______ ___ __ ________ ____ ___ ___ __ ________ _________ ____ ___'- ______ __ ___ __ __ ______
Any party in interest; including the Commonwealth and the personal representative, not
satisfied with the assessment may object thereto within sixty (60) doys ofter receipt of this
notice os provided by Section ]00] of the Inheritance and Estate Tax Act of ]96] (72 P.S.
9 2485-100 I)
Make check or money order payoble to:
"Register of Wills, Agent"
Mail to the oddress listed below: