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