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REV-483 (8-78)
COMMONWEALTH OF PENNSYLVANIA ..~- ~"
DEPARTMENT OF REVENUE
BUREAU OF FIE LD OPE RA TlONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASS~SSMENfi..QIf,; r:IiNNSYL VANIA
EST ATE TAX
DATE: /1- rill'-11
ESTATE OF, .J~5~ Co/I,,,",,,
~6~EN~~:OF: . ~.. ~~~~,~JJ
DATE OF DEATH: /{)-,:l/-1.i
8~/f~
TO:
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A. DETERMINATION:
1.. Taxable estate based upon:
vthe United States Estate Tax Return (Form 706)
The communication from the Federal Government
confirming the acceptance of or changes to the .:;a-
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) $ 0
4. Normal inheritance tax paid to other States or
Territories of the United States (excluding
any di scount and/or interest) $ 0
5. Total inheritance tax credits (line item 3 plus line item 4) $ t)
6. Total liability for Pennsylvania estate tax (line item 2
minu's line item 5) $ 0
NOTE: Complete line items 7 and 8 ONLY when determination
is based on Federal Closing Letter
8.
Amount of Pennsylvania estate tax assessed on determination
dated
Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7)
$
7.
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