Form Cat Rtfs - Commercial Activity Tax - Request To File Separately
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1CAT RTFS
Reset Form
Rev. 11/12
P.O. Box 16158
Columbus, OH 43216-6158
Commercial Activity Tax – Request to File Separately*
Primary taxpayer’s name
Address
City
State
ZIP code
FEIN or Social Security no.
CAT account no.
Member requesting to fi le separately
Address
City
State
ZIP code
FEIN or Social Security no.
CAT account no.
Reason for request to fi le separately (must list specifi c reasons/issues)
❑
Check here if continued on attached page
Note: This request may be made only by combined taxpayer groups. If this request is granted, the member requesting to
fi le separately may not elect to consolidate with other members of the same or a different taxpayer group. The tax com-
missioner may revoke special fi ling approval at any time.
Effective date of separate fi ling (if different from the succeeding tax period)
Note: Special approval by the tax commissioner is required for the separate fi ling to begin with the current tax period.
Please attach a letter documenting reasons for this request.
Primary taxpayer and member agree to the following: The separately fi ling member may not claim any of the group’s
$1 million annual exclusion. The member will fi le as a separate taxpayer and will be subject to the applicable tax rate on all of
the member’s taxable gross receipts without any exclusion. The separately fi ling member is fi nancially sound and currently
able to pay the commercial activity tax. All members, including the separately fi ling member, remain jointly and severally
liable for the combined group’s tax liability.
I hereby declare the above to be true and correct to the best of my knowledge and belief.
Primary taxpayer representative
Signature
Date (MM/DD/YY)
Representative of member requesting to fi le separate Signature
Date (MM/DD/YY)
Contact telephone no. (required)
E-mail
Please send this request to: Ohio Department of Taxation, CAT Division-CAT RTFS, P.O. Box 530, Columbus OH 43216-
0530 or fax to (614) 644-9641.
*This form is created pursuant to Adm. Rule 5303-29-08.
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