Rev. 4/13 
                                                                                              CAT REF 
                                                                                              Application for Commercial
                       Please do not 
                       use staples.                                                           Activity Tax Refund 
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 filed  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

Telephone                                    Title 

E-mail 

                                   Please send this application to: Ohio Department of Taxation, 
                        Business Tax Division – CAT REF, P.O. Box 16158 Columbus, OH 43216-6158. 
      *This form is created pursuant to R.C. section 5751.08. 

                                                                                                                      CAT REF
                                                                                                                      Rev. 4/13

                                Information and Pertinent Law Sections
To the extent that a refund is granted on this application,        is entitled. If the amount is not less than that claimed, the 
either in whole or in part, the Department of Taxation will        commissioner shall certify the amount to the director of     
calculate and include the appropriate amount of interest in        budget and management and treasurer of state for payment 
the refund payment made to the applicant. The applicant            from the tax refund fund created under R.C. 5703.052. If the 
should not include such interest in the “total amount of           amount is less than that claimed, the commissioner shall 
refund claimed.”                                                   proceed in accordance with R.C. 5703.70. 
Commercial activity tax refunds are governed by R.C.               (C) Interest on a refund applied for under this section,     
5751.08, which provides in pertinent part as follows:              computed at the rate provided for in R.C. 5703.47, shall be 
                                                                   allowed from the later of the date the tax was paid or when 
(A) An application for refund to the taxpayer of the amount        the tax payment was due. 
of taxes imposed under this chapter that are overpaid, paid         
illegally or erroneously, or paid on any illegal or erroneous      (D) A calendar quarter taxpayer with more than one million 
assessment shall be fi led with the tax commissioner, on the        dollars in taxable gross receipts in a calendar year other than 
form prescribed by the commissioner, within four years after       calendar year 2005 and prior to calendar year 2013 and that 
the date of the illegal or erroneous payment of the tax. The       is not able to exclude one million dollars in taxable gross 
applicant shall provide the amount of the requested refund         receipts because of the operation of the taxpayer’s business 
along with the claimed reasons for, and documentation to           in that calendar year may fi le for a refund under this section 
support, the issuance of a refund. If the refund request is        to obtain the full exclusion of one million dollars in taxable 
based on a payment made via paper check rather than                gross receipts for that calendar year. 
electronic, please provide copies of the front and back of 
the cancelled check.                                               (E) Except as provided in R.C. 5751.091, the tax commissioner  
                                                                   may, with the consent of the taxpayer, provide for the crediting  
(B) On the fi ling of the refund application, the tax commissioner  against tax due for a tax year the amount of any refund due 
shall determine the amount of refund to which the applicant        the taxpayer under this chapter for a preceding tax year.