LAST NAME:__________________________________________ |
First name: (Check appropriate box)
[_] Billy-Bob [_] Bobby-Sue
[_] Billy-Sue
[_]Bobby-Lee
[_] Billy-Joe [_] Bobby-Jo
[_] Billy-Mae
[_]Bobby- Ellen
[_] Billy-Ray [_] Bobby-Ann
[_] Billy-Jack
[_]Bobby-Beth
 |
Age:____(if unsure, guess)
Sex:____M____F____Not Sure____
Shoe size: ____Left ____Right |
Occupation:
[_]Farmer [_]Mechanic [_]Hair Dresser
[_]Waitress [_]Unemployed [_]Dirty Politician |
Spouse's Name:_____________________________
2nd Spouse's Name:__________________________
3rd Spouse's Name:__________________________
Lover's Name:_______________________________
2nd Lover's Name:____________________________ |
Relationship to spouse:
[_]Sister [_]Aunt
[_]Brother [_]Uncle
[_]Mother [_]Son
[_]Father [_]Daughter
[_]Cousin [_]Pet
|
| Number of children living in household:______ |
| Number of children living in shed:_____ |
| Number that are yours:_____ |
Mother's Name:__________________________
Father's Name:___________________________
(if not sure, leave blank) |
| Education: 1 2 3 4 (Circle
highest grade completed) |
| Do you [_] own or [_] rent your
mobile home? (Check appropriate box) |
Total number of vehicles you own: ____
Number of vehicles that still crank: ____
Number of vehicles in front yard: ____
Number of vehicles in back yard: ____
Number of vehicles on cement blocks: ____ |
Where you keep them firearms:
____truck ____shed ____bathroom ____bedroom____kitchen____pants |
Do you have a gun rack? [_]Yes [_]No
If no, please explain:_______________________________________
_______________________________________ |
| Model and year of your
pick-up:______________________194_ |
Newspaper/magazines you subscribe to:
[_]The National Enquirer [_]The Globe
[_]Soap Opera
Digest
[_]TV Guide
[_]Rifle and Shotgun |
Number of times you've seen a UFO:_____
Number of times you've seen Elvis: _____
Number of times you've seen Elvis in a UFO: _____ |
How often do you bathe:
[_]Weekly [_]Monthly
[_]Not Applicable |
Color of teeth:
[_]Yellow [_]Brownish-Yellow
[_]Brown [_]Black
[_]N/A [_]Teeth? |
| Brand of chewing tobacco you prefer:
[_]Red-Man |
How far is your home from a paved road?
[_]1 mile [_]2 miles [_]don't know |
|
