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''I EV-483 (8-78)
COMMONWEALTH 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:
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J. DETERMINATION:
1. Taxable estate based upon:
-.')l.The 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
L 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)
;J. 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
\3.
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: 7..
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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
=
=
=
s. 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 COMMONWEAL.TH
Date:
SEE REVERSE SIDE FOR INSTRUCTIONS