HomeMy WebLinkAbout11-28-79
REV-483 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
TO:
DATE:
ESTATE OF:
FILE NO:
COUNTY OF:
DATE OF DEATH:
/1-.1 R-11
'(j# f A-'1 , HI Ll I ,..J!.. -t3 4 11 /VI 0 /I ')
,.,;/1- '1"- 04-0 I
(In /VY\/v H P. /VIi)
$1- d21'J-1S'
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A. DETERMINATION:
1. Taxable estate based upon:
The United States Estate Tax Return (Form 706)
I/"'he communication from the Federal Govemment
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
(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
dated /0-1-11
Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7)
$
{J
o
8.
Determination prepared by:
Date:
$
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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 AMOUNT PAID
$
INTEREST
($ )
($ )
($ )
CREDIT
=
=
=
3. 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 COMMONWEALTH
Date:
SEE REVERSE SIDE FOR INSTRUCTIONS
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IN RE:
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e. JIll_I Md Couftty
n. ~n[fi'~lth .......1 ...
I......,
Docket No. 1- 1),173
PETITION FOR REFUND of Transfer Inheritance Tax.
AND NOW TO WIT
A. D. 19
, I certify
that the following is the action of the Board of Finance and Revenue
of the Commonwealth of Pennsylvania in this matter:
"And now to wit
"'It 3
A. D. 19 7t,
Refund is hereby granted in the amount of $ 151-97."
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BY ORDER OF THE BOARD OF FINANCE AND REVENUE
State Treasurer, Chairman
Attorney General
Secretary of the Commonwealth
Auditor General
~ecr of Rev~
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