Pass a ref if you want to change what the object is:
TestRef t = new TestRef();
t.Something = "Foo";
DoSomething(ref t);
void DoSomething(ref TestRef t)
{
t = new TestRef();
t.Something = "Not just a changed t, but a completely different TestRef object";
}
After calling DoSomething, t does not refer to the original 'new TestRef', but refers to a completely different object.
This may be useful too if you want to change the value of an immutable object, eg a string. You can't change the value of a string once it has been created, but by using a ref, you could create a function that changes the string for another one that has a different value.
Edit: As other people have mention. It is not a good idea to use ref unless it is needed. Using ref gives the method freedom to change the argument for something else, callers of the method will need to to be coded to ensure they handle this possibility.
Also. When the parameter type is an object, then object variables always act as references to the object. This means, when the ref keyword is used you've got a reference to a reference. This allows you to do things as described in the example given above. But, when the parameter type is a primitive value (eg int), then if this parameter is assigned to within the method, the value of the argument that was passed in will be changed after the method returns:
int x = 1;
Change(ref x);
Debug.Assert(x == 5);
WillNotChange(x);
Debug.Assert(x == 5); // Note: x doesn't become 10
void Change(ref int x)
{
x = 5;
}
void WillNotChange(int x)
{
x = 10;
}