CAT 1
                                                              Reset Form                                  Rev. 11/23
                                                                                                          Page 1
                    P.O. Box 16158
                    Columbus, OH 43216-6158
                    tax.ohio.gov

                                         Commercial Activity Tax Registration
                                         Please complete in black or blue ink – do not use pencil.

      Federal employer identification number         Social security number (if no FEIN)                  For state use only

  1. Type of organization (check only one):                   Association/trust           C corporation             LLC 

              LLP                        LTD (non-U.S.)       Partnership                 QSSS                      S corporation 
                                                              (other than LLP)
              Single-member              Sole proprietorship  Other (please describe)
              LLC 
                    If you selected anything other than sole proprietor, please complete Schedule A.

  2. When did you first become subject to the commercial activity tax? (MM/DD/YY)
  3. Annual amount of taxable gross receipts anticipated?
              Less than $1 million       $1,000,000 - $3,000,000              $3,000,001 - $6,000,000               Over $6 million 

  4.  Are     you a consolidated elected taxpayer, a combined taxpayer or a single entity taxpayer? Check only one. 
                                                                                                    Single entity 
              Consolidated elected         Consolidated elected             Combined
              with 80% ownership           with 50% ownership                                       taxpayer

      By checking either consolidated box above, the entities listed on Schedule B of this registration hereby 
      elect to file a consolidated return.

      If you are consolidated, are you including your non-U.S. entities (same ownership election as above)?
              Yes   No            N/A (currently do not have any non-U.S. entity)

  5. If you are a consolidated elected taxpayer or a combined taxpayer, please enter the total number of
      members, including yourself, and complete Schedule B (attached).
  6. A. Legal name of entity (sole proprietor complete 4B):

      B. Sole proprietor:

      Last name                                                               First name                            M.I.
  7. Trade name or DBA:

                                                                                                                    Date Received
                                                                                                                    (For state use only)

                                                                                                                    M M D D Y       Y
                                                              – over –

  Federal employer identification number                Social security number                                           CAT 1
                                                                                                                         Rev. 11/23
                                                                                                                         Page 2

  8. Primary address:

  Address of taxpayer’s principal office

  City                                                                                    State        ZIP code

  Country (if other than U.S.A.)
  9. Contact information

  Mailing address (if different from primary)

  City                                                                                    State        ZIP code

  Country (if other than U.S.A.)

  Office/home phone number                   Office/home fax number 

  E-mail address
10. List the state               or country
  under whose laws the taxpayer is organized (if applicable).
  11. If you are registered with the Ohio Secretary of State, enter your charter number, registration number or
  license-to-conduct-business number:
 
12. NAICS code:                              (For most current NAICS listing, visit us at tax.ohio.gov)

I hereby declare that this form has been examined by me and to the best of my knowledge and belief is true, correct, and 
complete.

Name of applicant or agent (please print)               Signature                                      Date (MM/DD/YY) 

         Options to submit this application: Electronically: tax.ohio.gov – Contact Us - Online Notice Response 
                 Service or gateway.ohio.gov – Online Notice Response Service: eFax – 206-666-4462; Mail: Ohio 
                 Department of Taxation, Business Tax Division - CAT 1, P.O. Box 16158, Columbus OH 43216-6158

        CAT 1   Schedule A           Rev. 11/23

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  ZIP code

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Country                                                         State 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Address                                                         City 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   CAT account no. (if issued) for primary entity:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  SSN 

                                                                                                              Schedule A – Commercial Activity Tax (CAT)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Name                                                            FEIN 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   SSN: 

                                               P.O. Box 16158 Columbus, OH 43216-6158             tax.ohio.gov
                                                                                                                                                                                                                                                                                                                partners or members. If you are a consolidated elected taxpayer or a combined taxpayer, list the information only for the primary entity.

                                                                                                                                                        Schedule A is to be completed by all taxpayers other than sole proprietorships. Please list the required information for either the corporate officers, 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Indicate: Officer*, general partner, managing partner or member         *                                                                 President, vice president, secretary, treasurer, statutory agent
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Name of filer: (as shown on line 4)       FEIN: 

        CAT 1   Schedule B           Rev. 11/23

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   State of organization                        Country of organization

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  1
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Please make additional copies                               of this schedule as necessary.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             2

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Type of organization                         NAICS code

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                ZIP code 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State 
                                                                                                                                                                                                                        and is automatically renewable unless cancelled by the registrant                                                                                                                                                                                                                CAT account no. (if issued) of primary                                          entity of consolidated or combined group:

                                                                                                                                                                                                                       eight calendar quarters

                                                                                                              Schedule B – Commercial Activity Tax (CAT)                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Address                                      City                                                                 Country 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Signature of applicant or agent 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                SSN:
                                                                                                                                                         Members of Consolidated Elected Taxpayers or Combined Taxpayer

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Social Security No. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 tax.ohio.gov
                                               P.O. Box 16158 Columbus, OH 43216-6158             tax.ohio.gov
                                                                                                                                                                                                                       A consolidated election will remain in effect for 
                                                                                                                                                                                                                                                                                          or revoked by the tax commissioner. Please complete the information below for each member of the consolidated elected or combined group.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Federal Employer ID No.    Name of Member of Consolidated Elected Taxpayer or Combined Taxpayer                   Trade name or DBA I hereby declare that this form has been examined by me and to the best of my knowledge and belief is true, correct, and complete.                 Date (MM/DD/YY)                 1 Organization type (association/trust, C corporation, LLC, LLP, LTD (non-U.S.), partnership, S corporation, sole proprietorship, other) 2                       For NAICS codes visit 
                                                                                                                                                                                                                                                                                                                                                                                                                                  Primary entity of consolidated or combined group: (as shown on line 4)                                        FEIN: