Form   
4255
(Rev. December 2012) 
Department of the Treasury 
Internal Revenue Service 
Recapture of Investment Credit 
a
 Attach to your income tax return.
 
a
 Information about Form 4255 and its instructions is at 
www.irs.gov/form4255
. 
OMB No. 1545-0166 
Attachment 
Sequence 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, quali
fying advanced energy project, 
or qualifying therapeutic discovery project property. (See the Instructions for Form 3468 for the year the investment credit pr
operty was placed in service 
for definitions.) If rehabilitation property, also show type of building. If energy property, show type. 
A 
B 
C 
D 
Original Investment Credit 
Computation Steps: 
Properties 
(see Specific Instructions) 
A 
B 
C 
D 
1 
Original rate of credit      .
.......
1 
2 
Cost or other basis    .    .
.......
2 
3 
Original credit (see instructions)
.....
3 
4 
Date property was placed in service      .    .    .
4 
5 
 
Date property ceased to be qualified  
investment credit property
.......
5 
6 
 
Number of full years between the date on line  
4 and the date on line 5 .
.......
6 
Recapture Tax 
7 
Recapture percentage (see instructions)    .    .
7 
8  
 
Tentative recapture tax. Multiply line 3 by 
the percentage on line 7 
.......
8 
9 
Add all the amounts on line 8 
.......................
9
10 
Enter the tentative recapture tax from property for which there was an increase in nonqualified
nonrecourse financing. Attach a separate statement (see instructions)     .
.........
10 
11 
Add lines 9 and 10     .    .
......................... 
11 
12 
Unused credits (see instructions) 
.......................
12 
13 
Subtract line 12 from line 11. See section 45K(b)(4) if you claim the nonconventional source fuel 
credit. Electing large partnerships, see instructions
.................
13 
14 
Recapture of qualifying therapeutic discovery project grant. Attach statement (see instructions)   .    .
14 
15 
Total increase in tax. Add lines 13 and 14. Enter here and on the appropriate line of your tax return  .
15 
For Paperwork Reduction Act Notice, see instructions. 
Cat. No. 41488C 
Form 
4255
 (Rev. 12-2012) 
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