Arkansas State Residency Application
Name:
(_) Billy-Bob (last) (_) Billy-Joe (_) Billy-Ray
(_) Billy-Sue (_) Billy-Mae (_) Billy-Jack (_) Billy-Jefferson
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right
Occupation: (_)Farmer (_)Mechanic (_)Hair Dresser (_)Unemployed
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 (_)TV Guide (_)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 (_)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
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