CAT CS
                                                                                                                                                         Rev. 12/17

                P.O. Box 16158
                Columbus, OH 43216-6158

                              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)
For taxpayers subject to the phase-out of the corporation franchise tax and the phase-in of the commercial activity tax (CAT), 2008 was 
the last report year for which certain credits were available. For all subsequent years, the credits automatically converted to credits against 
the CAT and may be claimed beginning July 1, 2008. As such, for CAT periods beginning on or after July 1, 2008, a taxpayer may apply 
any of the following unused corporation franchise tax credits against the CAT, provided the combined number of carryforward years under 
the corporation franchise tax and the CAT does not exceed the carryforward period allowed, if applicable. 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**   757.70 of Am. Sub. H.B.  
 Credit*                                   49 of the 132nd G.A.
   
 Ohio Motion Picture        Refundable     5751.54                       N/A               Period beginning
 Tax Credit                                                                                Jan. 1, 2013
 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.
**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.

                                                                                   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 Development Services Agency.
                                                                          
                                                                                 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
   credit
                                                                           
  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.

                                                                                Refundable Credits
                                   Must include credit certificate received from the Ohio Development Services Agency                                                                             

Ohio historic preservation tax credit .............................................................................................................................1.
Ohio motion picture tax credit .......................................................................................................................................2.
Jobs creation tax credit.................................................................................................................................................3. 
Jobs retention tax credit ...............................................................................................................................................4.
Total of lines 1 through 4 to be carried forward to the refundable tax credits line of the CAT return ............................5.

                                                                                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