Credit Repair | Marcus Best | North Carolina Tax & Financial Consultant

First Name:*

Last Name:*

DOB:

Address*

City:*

State*

ZIP:*

Home Phone*

Cell Phone*

Email Address*

1. What is your occupation?*

3. What is your filing status?*

6. Please list friends and family that need to file their tax return to participate in our $50 referral program*

a. Who is your cellphone provider?*

8. Dependents Name(s) DOB(s)*

a. How many months did they live with you?*

b. Name of the other parent and address if possible*

c. Do you and the parent live together*

d. Can anyone else claim your dependents?*

e. Are any dependents married and filing a joint return?*

a. Names, Relationship, Location

In addition please provide at least one of the following if you are claiming Head of Household:*

• Property taxes • Mortgage Interest/1098 • Rent paid/Landlord statement • Utility bill • Social Security Cards/Statement • Grocery receipts • Property Insurance • Home Repair and maintenance receipts • School, Medical, or Daycare records • Child care provider documents • Place of Worship/Employer Statement • Divorce Decree/Separation Agreement

Max. file size: 256 MB.

If you have reached the max you can upload above, use this section to upload additional documents.

• Property taxes • Mortgage Interest/1098 • Rent paid/Landlord statement • Utility bill • Social Security Cards/Statement • Grocery receipts • Property Insurance • Home Repair and maintenance receipts • School, Medical, or Daycare records • Child care provider documents • Place of Worship/Employer Statement • Divorce Decree/Separation Agreement

Max. file size: 256 MB.

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