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REV"4ej (8"18)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
INHERITANCE TAX SECTION
OFFICIAL NOTICE OF DETERMINATION
AND ASSESSMENT OF PENNSYLVANIA
ESTATE TAX
10-lf[- 'f
TO:
DATE:
ESTATE OF:
FILE NO:
COUNTY OF:
DATE OF DEATH:
~ 01</
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I,. DETERMINATION:
1. Ta~ estaie based upon:
~~e United States Estate Tax Return (Form 706)
The communication from the Federal Govemment
confinning the acceptance of or changes to the
Federal Estate Tax Return
2. Amount of credit lor State death taxes (as verilied)
3. Pennsylvania inheritance tax assessed
(excluding any discount and/or interest)
4. Honnal inheritance tax paid to other States or
Territories 01 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 lor Pennsylvania estate tax (line item 2
minus line item 5)
NOTE: Complete line items 7 and 8 ONL Y when determination
is based an Federal Closing Letter
7.
Amount of Pennsylvania estate tax assessed on determination
dated
Addition (reduction) to Pennsylvania estate tax (line item 6
minus line item 7)
8.
Determination prepared S.
Date:
$
370.cl1
$ ;L 73, Is, 70. Sf
$ ;;"9M?CX;
$
-'0 -u
3'7o.t1
;;"'Sf7. 7S-
$
$
$
--------------------------------------------- --------------------------------------------
B. ASSESSMENT:
1. Pennsylvania Estate Tax rellected on:
line item A (6)
line item A (8) $
2. Less credits:
DATE OF PAYMENT
AMOUNT PAID
INTEREST
($ )
($ )
($ )
3. Balance of Pennsylvania estate tax due
Interest is due Qt the rate of six (6) percent per annum from
CREDIT
=
=
=
$
to the date of payment.
Assessment prepared by:
AGENT FOR THE COMMONWeAl. TH
Dote:
SEE REVERSE SIDE FOR INSTRUCTIONS