Rev. 1/13 
                                                                                              CAT FF 
                P.O. Box 16158                                                                Request to Change
                Columbus, OH 43216-6158                                                       Filing Frequency 
Please do not use staples. 

CAT account number         FEIN or Social Security number 

Use only UPPERCASE letters. 
Reporting member's name 

Please check the appropriate box below: 

  Quarterly fi ling frequency 
 A taxpayer switching from a calendar year lingfifrequency to a calendar quarter filing frequency may, for the fi rst quarter 
 of the change, apply the full $1 million exclusion amount to the rstficalendar quarter return the taxpayer files that calendar 
 year. Such taxpayers may carry forward and apply any unused exclusion amount to subsequent calendar quarters within  
 that same calendar year. The tax rate shall be based on the rate imposed in the calendar quarter in which the taxpayer  
 switches from a calendar year taxpayer to a calendar quarter taxpayer. Effective date (MM/DD/YY): 

Annual fi ling frequency
 Annual fi ling frequency is effective in the current calendar year if the request is approved by the tax commissioner before  
 the due date of the annual minimum tax (due May 10 of each year). Otherwise, the annual fi ling frequency is effective the  
 following calendar year. Effective date (MM/DD/YY): 

NOTE: By checking the box above, the taxpayer affi rms that it will have less than $1 million in taxable gross receipts for 
the current calendar year. 

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 change fi ling frequency. 

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) 

City                                                          State   ZIP code 

Telephone                         Fax 

Title                                                      E-mail 

                Please send this request to: Ohio Department of Taxation, Business Tax Division, 
                           P.O. Box 16158 Columbus, OH  43216-6158 or fax to (206) 666-4462.