Form 4255 (Rev. December 2016) Department of the Treasury Internal Revenue Service Recapture of Investment Credit ► Attach to your income tax return. ► Information about Form 4255 and its separate instructions is www.irs.gov/fonn4255. OMB No. 1545-0166 Attachment Sequenze No. 172 Name(s) as shown on return Identifying number properties Type of property—State whether rehabilitation. energy. qualifying advanced coal project. qualifying gasification project, qualifying advanced energy project. or qualifying therapeutic discovery project property. (See the Instructions for Form 3068 for the year the investment credit property was placed in service for definitions.) If rehabilitation property. also show type of building. If energy property, show type. A B C D • art I Original Investment Credit These columns relate to the properties A 1 Properties through D described above ► A B C D 1 Original rate of credit 1 2 Credit (see instructions) base as of the end of the previous tax year 2 3 Net change during negative in nonqualified nonrecourse financing the tax year. If a net decrease, enter as a number 3 4 Credit Subtract base as of the end of the current tax year line 3 from line 2 4 5 Refigured credit (see instructions) 5 6 Credit taken prior years. for this property on Form 3800 in See instructions 6 Part II Recapture From Increase in Nonqualified Nonrecourse Financing (see instructions) 7 Credit subject to recapture due to a net increase in nonqualified nonrecourse financing. Subtract line 5 from line 6. If zero or less, enter -0- 7 8 Unused general business credits that would have been allowed if original credit had been figured with current-year credit base (see instructions) . . . 8 9 Subtract line 8 from line 7. This is the recapture tax as a result of a net increase in nonqualified nonrecourse financing g Part III Recapture From Disposition of Property or Cessation of Use as Investment Credit Property 10 Date property was placed in service . . . . 10 11 Date property ceased to be qualified investment credit property 11 12 Number of full years between the date on line 10 and the date on line 11 12 _ 13 Unused general business credits that would have been allowed had there been no credit from this property (see instructions) 13 14 Subtract line 13 from line 6 14 15 Recapture percentage (see instructions) . . . 15 16 Multiply line 14 by the percentage on line 15 . . 16 17 Add property columns A through D, line 9 17 18 Add property columns A through D, line 16 18 19 Recapture of qualifying therapeutic discovery project grant. Attach statement (see instructions) . . . 19 20 Total increase in tax. Add lines 17, 18, and 19. (See section 45K(b)(4) if you claim the nonconventional source fuel credit.) Enter here and on the appropriate line of your tax return 20 For Paperwork Reduction Act Notice, see Instructions. Form 4255 (Rev. 12-2016) EFTA01222697