Form Rbic-A - Residential Historic Rehabilitated Buildings Investment Credit Page 2

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SCHEDULE RBIC-A

Residential Historic Rehabilitated

Form

Buildings Investment Credit

RBIC-A

Rev. 01/01

(For Investments Made After December 31, 1999)

Name

Tax Identification Number

Street Address

City

State

Zip Code

1. Qualified rehabilitation expenditures for certified residential historic structures

(attach certification certificate). .................................................................................................................

2. Qualified rehabilitation expenditures incurred on or after December 31, 1999. .......................................

3. Credit (Enter 20% of amount shown on Line 2). ......................................................................................

4. Enter certification number. ........................................................................................................................

5. Enter your pre-credit income tax liability. ..................................................................................................

6a. Enter amounts of other credits claimed (i.e. Tax paid to other States,

Business Investment and Nonfamily Adoption) ........................................................................................

6b. Subtract amount on Line 6a from the amount on Line 5. .........................................................................

7. Total allowed credit - Enter smaller of Line 3 or Line 6b.

This is your current year's credit ...............................................................................................................

8. Excess Credit To Be Carried Forward:

Subtract amount on Line 7 from the amount on Line 3. ...........................................................................