Arkansas State Residency Application

Name: ________________ (_) Billy-Bob 
(last) (Check appropriate box)
(_) Billy-Joe   (_) Billy-Ray
(_) Billy-Sue   (_) Billy-Mae 
(_) Billy-Jack  (_) Billy-Jefferson
 
Age: ____
Sex: ____ M _____ F _____ N/A 
Shoe Size: ____ Left ____ Right 

Occupation: 
(_)Farmer   (_)Mechanic
(_)Hair Dresser 
(_)Un-employed

Spouse's Name:_______________________
Relationship with spouse:
(_) Sister    (_) Brother
(_) Aunt   (_) Uncle
(_) Cousin    (_) Mother
(_)Father   (_) Son
(_) Daughter  (_) Pet

Number of children living in household: ___
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

Firearms you own and where you keep them:
____ truck   ____ bedroom  ____ bathroom  ____ kitchen  ____ shed

Model and year of your pickup: ___________194_

Newspapers/magazines you subscribe to:
(_)The National Enquirer  (_)The Globe  (_)TVGuide  (_)Soap Opera Digest

___ 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  (_)Green  (_)N/A

Brand of chewing tobacco you prefer:
(_)Red-Man
How far is your home from a paved road?
(_)1 mile  (_)2 miles  (_)don't know