Request To Cancel/ Reactivate Account Form
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1CAT CR
Rev. 9/07
Request to Cancel/
Please do not
Reactivate Account
use staples.
CAT account number
FEIN/SSN
Use only UPPERCASE letters.
Reporting member's name
/
/
/
/
Please cancel my CAT account effective
Reason for cancellation:
Gross receipts less than $150,000
Merger
Out of business
Sold business
Revoked
Other
Dissolution
Bankruptcy
/
/
/
/
Please reactivate my CAT account effective
Reason for reactivation:
Gross receipts greater than $150,000
Other
*Please note: If reactivating a combined or consolidated taxpayer group, all members that were part of the group on the cancellation date will be
reactivated. If group members have changed, please complete form CAT AR (Add/Remove a Member to/from Group).
If applicable, please submit the following forms (forms can be printed from the Department of Taxation Web site at tax.ohio.gov):
CAT C3 – Change in Mailing or Location Address Form
CAT AR – Add/Remove a Member to/from Group – CAT Consolidated Elected and Combined Taxpayer Groups
CAT ES – Request to Change Election Status
CAT FF – Request to Change Filing Frequency
CAT RTFS – Request to File Separately
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 file this request to cancel/reactivate account.
Signature
Date
Name
Title
Contact person: The taxpayer will be represented in the matter by the following individual. Please attach a Declaration of Tax
Representative (form TBOR 1), which can be found on the department’s Web site at tax.ohio.gov.
Your first 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, CAT Division,
P.O. Box 16158, Columbus, OH 43216-6158 or fax to (614) 644-9641.
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