CAT CS
                                                                                                                                                         Rev. 11/23

                           Commercial Activity Tax Credit Schedule
CAT account number (of primary reporting entity)                               FEIN/SSN
Reporting member’s name
Street address (number and street)
City                                                             State                    ZIP code
Period covered (MM/DD/YY)                                         to (MM/DD/YY)
                                        (Quarter for which this report is being submitted)
Please see O.A.C. 5703-29-22 contained in information release CAT 2007-03 for more detailed information regarding the CAT credits.

 Credit                   Refundable or  Ohio Revised Code                Carryforward    First Period Credit Can
                          Nonrefundable  Section                          Period          Be Used Against the CAT
 Jobs Retention Tax       Nonrefundable  5751.50(B) & 122.171          Three years            Period beginning
 Credit                                                                                                                                      July 1, 2008
   
 Credit for Qualified     Nonrefundable  5751.51                          Seven years           Period beginning 
 Research Expenses                                                                        July 1, 2008
   
 Credit for R&D           Nonrefundable  5751.52                          Unlimited       Period beginning
 Loan Payments                                                                                                                       July 1, 2008
   
 Credit for Unused        Nonrefundable  5751.53                          Twenty years    2010
 NOLs
 Ohio Historic            Nonrefundable/ Uncodified Section               Five years      2014
 Preservation Tax         Refundable**   757.40 of Am. Sub. H.B.  
 Credit*                                 166 of the 133rd G.A.
   
    Ohio Motion Picture   Refundable     5751.54                          N/A             Period beginning
   and Broadway                                                                           Jan. 1, 2013
 Theatrical Production 
 Credit
  
 Film and Theater 
 Capital Improvement      Refundable     5751.55                          N/A             Period beginning
  Project Credit                                                                          Jan. 1, 2024

 Jobs Creation Tax        Refundable     5751.50(A) & 122.17              N/A             Period beginning                                                                                 
 Credit                                                                                   July 1, 2008
 Jobs Retention Tax       Refundable     5751.50(B) & 122.171             N/A             Period beginning                                                                            
 Credit                                                                                   Jan. 1, 2011
 Credit for Unused        Refundable     5751.53                          N/A             2030
 NOLs
*Credit can be claimed against CAT provided that the taxpayer is unable to claim the credit under Ohio Revised Code sections 5725.151, 5725.34, 5726.52, 
5729.17, 5733.47 or 5747.76. The credit certificate must have an effective date after December 31, 2013, but before June 30, 2021.
**In the event that the nonrefundable credit is not fully utilized, the excess shall be refunded to the taxpayer. However, if any amount of the credit is refunded, 
the sum of the amount refunded and the amount applied to reduce the tax otherwise due for that year shall not exceed $3 million. The taxpayer may then carry 
forward any excess balance for not more than five calendar years.
To submit this application, please use one of the following options:
Online Notice Response Service:                     eFax:                        Mail:
tax.ohio.gov - Contact Us                           206-666-4462                 Ohio Department of Taxation                                              
- or - gateway.ohio.gov                                                          Business Tax Division - CAT CS  
                                                                                 P.O. Box 16158  
                                                                                 Columbus, OH 43216-6158                                                  

                                                                                                                         CAT CS
                                                                                                                         Rev. 11/23
                                                    Credit Schedule
(If credits are being claimed by members of a consolidated elected or combined taxpayer group,   a separate schedule is required for 
each entity that is claiming a credit.)
The CAT account number of the entity entitled to the credit may be different than that of the primary reporting entity.
Entity entitled to credit: Name                             FEIN                   CAT account number

                                                 Nonrefundable Credits
            + Must include credit certificate received from the Ohio Department of Development.

                                                  A                B                              C                     D

                                        Opening Unused      Credits Earned         Credits Claimed 
                                                                                                                       Closing Unused
                                        Credit Balance      During Current         During Current 
                                                                                                                       Credit Balance
                                                                 Reporting Period       Reporting Period 
 
  1. Jobs retention tax credit +

  2. Qualified research expense tax                         complete calculation 
   credit                                                   below
                                          
  3. Research and development loan 
    repayment tax credit +
  4. Ohio historic preservation tax 
   credit  +

  5. Total                                                                        *

*Combine with credits being claimed by other entities in the group (if any) and carry this forward to the nonrefundable credits line on your 
CAT return.

                                     Qualified Research Expense Tax Credit Calculation

                                                 Current Calendar Year (20____) Expenses:

Prior calendar year 1 (20____) expenses:

Prior calendar year 2 (20____) expenses:

Prior calendar year 3 (20____) expenses:

                                                            Average of 3 prior year expenses:

                                                                                  Difference:

                                                                     7% of difference:

                                      Credit earned (include this amount in the closing balance):

Address where the qualified research expenses were incurred:

                                                                             Refundable Credits                                                                             CAT CS
                                                                                                                                                                            Rev. 11/23
                                   Must include credit certificate received from the Ohio Department of Development                                                                             

Ohio historic preservation tax credit .............................................................................................................................1.
Ohio motion picture and Broadway theatrical production credit ...................................................................................2.
Film and theater capital improvement projects credit ...................................................................................................3.
Jobs creation tax credit.................................................................................................................................................4. 
Jobs retention tax credit ...............................................................................................................................................5.
Total of lines 1 through 5 to be carried forward to the refundable tax credits line of the CAT return ............................                                       6.

                                                                             Declaration and Signature 
                                    (an officer or managing agent of the corporation must sign this declaration)

 I declare under penalties of perjury that this report (including any        use any of its money or property for or in aid of or opposition to 
 accompanying schedule or statement) has been examined by                    a political party, a candidate for election or nomination to public 
 me and to the best of my knowledge and belief is a true, correct            office, or a political action committee, legislation campaign fund, 
 and complete return and report, and that this corporation has not,          or organization that supports or opposes any such candidate or 
 during the preceding year, except as permitted by Ohio Revised              in any manner used any of its money for any partisan political 
 Code sections 3517.082, 3599.03 and 3599.031, directly or                   purpose whatsoever, or for reimbursement or indemnification of 
 indirectly paid, used or offered, consented, or agreed to pay or            any person for money or property so used.
                                   

 Date (MM/DD/YY)                    Signature of officer or managing agent                             Title

 Contact phone number                                                        E-mail