3

CAT AR                                                 Rev. 5/13

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                                                                                                                                                                                                                                                                                                                                                                                                  State/country of incorporation       Effective date (MM/DD/YYYY)                                                                                                                                                                 (if applicable)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              (if applicable)
                                                                                                                                                                                                                                                                                                                                                                          1 

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               You must  attach a complete organizational chart 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   code
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                led.                                                                                                                                                                                                   
                                                                                                                                                                                                               ling status.)
                                                                                                                                                                                                                                                                                                                                                                                                  Type of ownership                                                                NAICS                                                                      Reason for removal                                                   Reason for addition 
                                                                                                                                                                                                                                                                                                                 Reporting Member                      Name

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              ZIP code                                                              
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Any member acquired or formed after the filing of the initial registration shall be                                                                                    included in the group. The group must notify the tax commissioner of any additions                                                                                                          with the next tax return fi                       (including percentages of ownership between all entities) showing the busi-                                                                           ness structure that reflects its common owner for purposes of the CAT. The                                                                                                                        chart must comply with R.C. 5751.011, R.C. 5751.012, and O.A.C. 5703-29-02.                                                                                                                              Please make additional copies of this form as necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State                                                                 

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                      a Member to/from Group

                                                                                                                                                                                                                                                                                                                                                                                                  (only required when adding members)
                                                                Commercial Activity Tax (CAT) 

                                            ADD/REMOVE                                                                                                                                                                                                                                                                            Reporting Member         FEIN/SSN                               Address                                                                          Address                                                                    City                                                                 Country 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     E-mail 
                                                                                                             Consolidated Elected and Combined Taxpayer Groups
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Signature

                                                                                                                                                                                                              (This form only applies to existing taxpayer groups. Please complete form CAT ES for changing the fi

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               and click on “Forms” and under the “Other Form Resources” section, click on the 
                                                                                                                                                                                                                                                                                                                                                                                                  FEIN/SSN                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              tax.ohio.gov
                                                                                              P.O. Box 16158                                                  Columbus, OH 43216-6158             tax.ohio.gov
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Remove  Remove Remove       Remove

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Add     Add    Add          Add
                                                                                                                                                                                                                                                                                                                                  Reporting Member CAT     Account Number                         Add/remove (select one)                                                          Name of member of consolidated elected/combined taxpayer                   Trade name or DBA                                                    Already registered for CAT? Please provide acct. #                                            I hereby declare the above to be true and correct to the best of my knowledge and belief.                   Date (MM/DD/YYYY)                       Contact telephone no.   1                                                                                                                        Ownership type (e.g., association, trust, C corporation, LLC, LLP, LTD, partnership, S corporation, single member LLC,                                                                                    sole proprietor, other)                                                                                                                                               2                       For NAICS codes visit                                                                                                             link for NAICS codes.                                                       3                                                                                                                                                   “Effective date” refers to the date this entity became a member of the consolidated elected or combined taxpayer group or the date this entity was removed from the consolidated elected or combined taxpayer group for fi   4 Reasons for removal (e.g., out of business, sold business, merger, dissolution, bankruptcy, etc.)                                                         5                                                                 Reasons for addition (e.g., reorganized, merger, acquired, etc.)