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REV-.83 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
II'lHERITAI'lCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSeSSMENT OF PENNSYLVANIA
ESTATE TAX
/CJ-/69-J
DATE: ~ -/:J- -79'
ESTATE OF: . A t< I/e.~ 13. r; D" d
FILE NO: ?, ~ 33Z
COUNTY OF: C!.i bf?.e -1.-l
DATE OF DEATH: {p - ::L 3- 7R
TO:
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A. DETERMINATION:
1. Taxable estate based upon:
~ United States Estate Tax Return (Form 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 (os verified)
3. Pennsylvania inheritance tax assessed
(excluding any discount and/or interest)
4. Normal inheritance tax paid to other States or
Territories of the United States (excluding
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
7.
Amount of Pennsylvania estate tax assessed on determination
doted
Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7)
8.
Determination prepared by:
Dote:
$ (/~ 99~()d
$ <;; (1'17. g.i.j
,
~~37tJ. If
$_6 -
$ ;)$370, I if
$
-<....)-
$
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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 rote of six (6) percent per annum from
$
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 assessment is made in accordance 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 at the date of the decedent's death but shall
not become del inquent unti I the expiration of eighteen (18) months after decedent's death provided
that any estate tax occosioned by 0 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 following interest tab'e:
---~----------------------------------------------------------------------------.
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 .(l15 6 months .030 9 months .045 12 months .060
1 day .00017 11 days .00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 day s .00437
7 days .00118 17 day s .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days .00488
10 days .00 169 20 days .00335 30 days .00500
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Any party in interest, induding the Commonwealth and the personal representative, not
satisfied with the ossessmentmay object thereto within sixty (60) days after receipt of this
notice as provided by Section 1001 of the Inheritonce 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: