OMB No. 1545-0166 
Form   4255                            Recapture of Investment Credit 
(Rev. December 2016)                             ▶ Attach to your income tax return.                                                           Attachment 
Department of the Treasury ▶ Information about Form 4255 and its separate instructions is at www.irs.gov/form4255.                             Sequence No.  172 
Internal Revenue Service 
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 3468 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 
Part I      Original Investment Credit 
   These columns relate to the properties A                                                                          Properties 
   through D described above       . . .     . . .    . ©          A                         B                                   C                   D 
1  Original rate of credit     . . . . .     . . .    .    1 
2  Credit base as of the end of the previous tax year 
   (see instructions)  .     . . . . . .     . . .    .    2 
3  Net change in nonqualified nonrecourse financing 
   during the tax year. If a net decrease, enter as a 
   negative number .         . . . . . .     . . .    .    3 
4  Credit base as of the end of the current tax year. 
   Subtract line 3 from line 2 .   . . .     . . .    .    4 
5  Refigured credit (see instructions) .     . . .    .    5 
6  Credit taken for this property on Form 3800 in 
   prior years. 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       . . . . .     . . .    .    9
Part     IIIRecapture 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.                Cat. No. 41488C                                                        Form 4255 (Rev. 12-2016)