Plez compleet this paper, best ya can.
Last name: ________________
First name:
[_] Billy-Bob [_] Bobby-Sue [_] Billy-Joe [_] Bobby-Jo [_] Billy-Ray
[_] Bobby-Ann [_] Billy-Sue [_] Bobby-Lee [_] Billy-Mae [_] Bobby-Ellen
[_] Billy-Jack [_] Bobby-Beth Ann Sue
Age: ____ (if unsure, guess)
Sex: [_]M [_]F [_]None
Shoe Size: ____ Left ____ Right
Occupation:
[_] Farmer [_] Mechanic [_] Hair Dresser [_] Waitress
[_] Un-employed [_] Dirty Politician
Spouse's Name: __________________________
2nd Spouse's Name: __________________________
3rd Spouse's Name: __________________________
Lover's Name: __________________________
2nd Lover's Name: __________________________
Relationship with spouse:
[_] Sister [_] Aunt [_] Brother [_] Uncle [_] Mother
[_] Son [_] Father [_] Daughter [_] Cousin [_] Pet
Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___
Mother's Name: _______________________
Father's Name: _______________________
Education: 1 2 3 4 (Circle highest grade completed)
If you obtained a higher education what was your major?
[_] 5th grade [_] 6th grade
Do you [_] own or [_] rent your mobile home?
Vehicles you own and where you keep them:
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 ___
Age you started drivin ______
(If over 10 are you are still slow lerrnin ? [_] Yes [_] No)
Firearms you own and where you keep them:
____ truck ____ kitchen ____ bedroom
____ bathroom/outhouse ____ shed ____ pawnshop
Model and year of your pickup: _____________ 194_
Do you have a gun rack? [_] Yes [_] No
If no, please explain: ____________________
Newspapers/magazines you subscribe to:
[_] The National Enquirer [_] The Globe [_] TV Guide
[_] Soap Opera Digest [_] Rifle and Shotgun [_] Bassmasters
___ 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
How many teeth in YOUR mouth? ___
Color of teeth:
[_] Yellow [_] Brownish-Yellow [_] Brown [_] Black [_] N/A
Brand of chewing tobacco you prefer: [_] Red-Man [_] Skoal
How far is your home from a paved road?
[_] 1 mile [_] 2 miles [_] don't know
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