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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
AnN E RHOADS
CLECKNER & FEAREN
PO BOX 11847
HARRISBURG PA 17108
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
REV-736 EX AFP (06-05)
04-24-2006
CLECKNER
12-24-2004
21 05-0040
CUMBERLAND
202
APPEAL DATE: 06-23-2006
(See reverse side under Objections)
Amount Remitted I
MAKE CHECK PAYABLE
RICHARD
W
I
AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES +-
RE-V=736--EX--AFP--Coi:-02i-----.-i-NO-ffcE--OF--DETEFlMIN-AiIo-N-AN-D-As-sEss-HENT-----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ..
ESTATE OF CLECKNER
RICHARD
W FILE NO.21 05-0040
ACN 202
DATE 04-24-2006
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
16,200.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
56,897.55
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
56,897.55
5. Pennsylvania Estate Tax Due
.00
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
.00
7. Additional Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE
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