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REV-483 \8-781
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATrONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
!O-!b 7- P
TO:
DATE:
ESTATE OF:
FILE NO:
COUNTY OF:
DATE OF DEAT1i:
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A. DETERMINATION:
1. Taxable estate ba sed upon:
~nited States Estate Tax Return (Farm 706)
The communication from the Federal Government
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
(exc:ludi ng any di scount and/or interest)
4. Normal inheritance tax paid to other States or
Territories of the United States (exc:luding
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
$ 1m 3S-1, 72-
$ .3 2..;l., 8 /
$3/1If0
/
-G-
$ g/9/.s-; b 6
$
,
$ --0 -
7. Amount of Pennsylvania estate tax assessed on determination
dated $
8. Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7) ~ $
....~I"',;." ...p..... by' _ d t1!~ ~
Date: _ /0 _9~9.
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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
INTEREST
($ )
($ )
($ )
AMOUNT PAID
3. Balance of Pennsylvania estate tax due
Interest is due at the rate of six (6) percent per annum fram
$
CREDIT
=
=
=
$
to the date of payment.
Assessment prepared by:
AGENT FOR THE COMMONWEAL TH
Date:
SEE REVERSE SIDE FOR INSTRUCTIONS
INSTRUCTIONS
To insure proper credit to your account, the name of the estate and file number should be
clearly pri nted on the check or money order.
This determination and ossessment is mode in occordance with Section 421 and Section 732
of the Inheritance and Estate Tax Act of 1961, 72 P.S. 2485-421,732.
The estate tax imposed by Section 421 is due ot the dote of the decedent's death but shall
not become delinquent until the expiration of eighteen (18) 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
shall 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 fo! lowing interest tab' e:
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1 mo n th .005 4 months .020 7 months .035 10 months .050
2 months .0lD 5 months .025 8 months .040 11 months .055
3 months .015 6 months .030 9 months .045 12 months .060
1 doy .00017 11 doys .00186 21 doys .lt0352
2 days .00034 12 doys .00203 22 doys .00369
3 doys .00051 13 days .00220 23 doys .00386
4 days .00068 14 doys .00237 24 days .00403
5 doys .00085 15 days .00250 25 doys .00420
6 doys .00101 16 days .00267 26 days . G0437
7 days .00118 17 day s .00284 27 days .00454
8 doys .00135 18 do ys .00301 28 days .00471
9 days .00152 19 days .00318 "ZJ days .00488
10 doys .DO 16.9 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 aspravided by Section 1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S.
~ 2485-1001)
Make check or money order payable to:
"Reg ister of Wi lis, Agent"
Mail to the address listed below: