Form Cat Ref - Application For Commercial Activity Tax Refund
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CAT REF
Rev. 4/13
Application for Commercial
Please do not
Activity Tax Refund
use staples.
CAT account number
FEIN/SSN
Use only UPPERCASE letters.
Reporting member's name
Street address (number and street)
City
State
ZIP code
Contact's fi rst name
M.I.
Last name
Telephone
Fax
Title
E-mail
Time period covered by the refund request (MM/DD/YY)
to (MM/DD/YY)
$
Total amount of refund claimed
State full and complete reasons for the above claim. You may attach additional sheets and/or supporting documentation.
Note: This application must be fi led within four years from the date of the erroneous payment of the tax. Refund applications may
only be submitted by primary registrants; members may not submit refund requests.
SIGN HERE (required)
I declare under penalty of perjury that I am the taxpayer or the taxpayer’s authorized agent having knowledge of the relevant facts in
this matter to fi le this refund application.
Signature
Date (MM/DD/YY)
Name
Title
Taxpayer representative: The taxpayer will be represented in the matter by the following individual. Please attach a Declaration of Tax
Representative (Ohio form TBOR 1), which can be found on the department’s Web site at tax.ohio.gov.
First name
M.I.
Last name
Title
Telephone
E-mail
Please send this application to: Ohio Department of Taxation,
CAT Division – CAT REF, P.O. Box 16158 Columbus, OH 43216-6158.
*This form is created pursuant to R.C. section 5751.08.
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