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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*
COUNTY FILE NO:
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ESTATE
FILE NO.
COUNTY
DATE OF DEATH
Appraised Value of Estate:
Real Estate
$
9yLfo,00
;) Cj t..j. r; LI
r
Personal Property
+
r- ~
Jointly Held Property /Transfers
+
Total Gross Estate
$
9 7 3 ,/-, 9 t/
Lf Cj63f.SIJ
'I- 7 5/. Vf--
Total Approved Deductions
Clear Value of Estate
$
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$
Lf~51,if(j.
Amount Taxable @ 6% Rate
$ l.J-r) S I. '1-1./..
tax due
$ ;}.gB.Or;
Amount Taxable @ 15% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$ ~ }:;, Or
* * * * * * A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DA TE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$
+ $
$
= $
+
=
+
Interest accrues at the rate of six (6) percent p~~num fi C;
on the unpaid balance of Inheritance Tax from ~ . I 5. I II! '7 L I
to date of payment. Interest due if paid by / 4~,?"(J is.)<< h'.3
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE $
( ~_I f;. 'it ')
( __1.1; - '6U
" L .,V t~; )
FiEC; J STE n OF
INFORMATION
. To insure proper credit to your account, the name of the estate and file number should be clearly print-
ed on the check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. 9 2485-708).
To the extent that inheritance tax is paid within three (3) months after the death of the decedent, a
discount of five (5) percent is allowed (72 P.S. 9 2485-716).
Inheritance Tax, other than tax on a future interest, is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P.S. 9 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 2485-712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
--------------------- ----------.--- ------------- - - --- - --- -------- -- -- - - - -- --
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 .015 6 months .030 9 months .045 1 2 months .060
1 days .00017 11 days .00186 21 days .00352
2 days .00034 1 2 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 days .00437
7 days .00118 17 days .00284 27 days .00454
8 days .00135 1 8 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days .00488
10 days .00169 20 days .00335 30 days .00500
__ ___________________ _.__ - ___ __ ___ __ - - ____ __ - ___.____ - - - - _________ _____00
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 as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 (72 P.S. 9 2485-1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below: