Reset Form
ADD/REMOVE
CAT AR
a Member to/from Group
Rev. 5/13
Commercial Activity Tax (CAT)
P.O. Box 16158
Consolidated Elected and Combined Taxpayer Groups
Columbus, OH 43216-6158
(This form only applies to existing taxpayer groups. Please complete form CAT ES for changing the fi ling status.)
tax.ohio.gov
Reporting Member
Reporting Member CAT
Reporting Member
Name
Account Number
FEIN/SSN
1
Add/remove (select one)
FEIN/SSN
Address (only required when adding members)
Type of ownership
State/country of incorporation
Name of member of consolidated elected/combined taxpayer Address
NAICS code
2
Effective date (MM/DD/YYYY)
3
Trade name or DBA
City
State
ZIP code Reason for removal (if applicable)
4
Already registered for CAT? Please provide acct. #
Country
Reason for addition (if applicable)
5
Add
Remove
Add
Remove
Add
Remove
Add
Remove
I hereby declare the above to be true and correct to the best of my knowledge and belief.
Date (MM/DD/YYYY)
Signature
Contact telephone no.
E-mail
1
Ownership type (e.g., association, trust, C corporation, LLC, LLP, LTD, partnership, S corporation, single member LLC,
Any member acquired or formed after the fi ling of the initial registration shall be
sole proprietor, other)
included in the group. The group must notify the tax commissioner of any additions
2
For NAICS codes visit tax.ohio.gov and click on “Forms” and under the “Other Form Resources” section, click on the
with the next tax return fi led. You must attach a complete organizational chart
link for NAICS codes.
(including percentages of ownership between all entities) showing the busi-
3
ness structure that refl ects its common owner for purposes of the CAT. The
“Effective date” refers to the date this entity became a member of the consolidated elected or combined taxpayer group
chart must comply with R.C. 5751.011, R.C. 5751.012, and O.A.C. 5703-29-02.
or the date this entity was removed from the consolidated elected or combined taxpayer group for fi ling purposes
4
Reasons for removal (e.g., out of business, sold business, merger, dissolution, bankruptcy, etc.)
Please make additional copies of this form as necessary.
5
Reasons for addition (e.g., reorganized, merger, acquired, etc.)