Form Cat Cr - Request To Cancel/reactivate Account
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1CAT CR
Rev. 7/10
Reset Form
Request to Cancel/
Please do not
Reactivate Account
use staples.
CAT account number
FEIN/SSN
Use only UPPERCASE letters.
Reporting member's name
/
Please cancel my CAT account effective (MM/DD/YY)
Reason for cancellation:
/
Taxable gross receipts less than $150,000
Business closed. Date (MM/DD/YY):
Bankruptcy. Case no:
Organizational change. New FEIN:
Sold/merged business. Please provide the following information regarding the company or individual to whom the business was
sold or with whom the business merged:
Name of company/individual
Address of company/individual
FEIN of company/individual
CAT account no. of company/individual
Effective date of sale/merger (MM/DD/YY)
/
/
Please reactivate my CAT account effective (MM/DD/YY)
Reason for reactivation:
Gross receipts greater than $150,000
Other
*Please note: If reactivating a combined or consolidated taxpayer group, all members that were part of the group on the cancellation
date will be reactivated. If group members have changed, please complete form CAT AR (Add/Remove a Member to/from Group).
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 request to cancel/reactivate account.
Signature
Date (MM/DD/YY)
Name
Title
Contact person: 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.
Your fi rst name
M.I.
Last name
Home address (number and street)
C
C ity
State
ZIP code
Telephone
Fax
Title
E-mail
Please send this request to Ohio Department of Taxation, CAT Division,
P.O. Box 16158, Columbus, OH 43216-6158 or fax to (614) 644-9641.
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