Pleeze compleet this paper, best ya can.


Last name: ______________________________


First name:
[_] Billy-Bob
[_] Billy-Joe
[_] Billy-Ray
[_] Billy-Sue
[_] Billy-Mae
[_] Billy-Jack
[_] Badd-Teddy Bob
[_] Bobby-Sue
[_] Bobby-Jo
[_] Bobby-Ann
[_] Bobby-Lee
[_] Bobby-Ellen
[_] Bobby-Beth


Age: ____ (if unsure, guess)
Sex: [_]M [_]F [_]None
Shoe Size: ____ Left____ Right


Occupation:
[_] Farmer
[_] Hair Dresser
[_] Un-employed

[_] Mechanic
[_] Waitress
[_] Dirty Politician


Spouse's Name: ______________________________
2nd Spouse's Name: __________________________
3rd Spouse's Name: __________________________
Lover's Name: _______________________________
2nd Lover's Name: ___________________________


Relationship with spouse:
[_] Sister
[_] Brother
[_] Mother
[_] Father
[_] Cousin

[_] Aunt
[_] Uncle
[_] Son
[_] Daughter
[_] Pet


Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___


Mother's Name: _______________________
(Relation__________)
Father's Name: _______________________
(Relation__________)


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
____ bedroom
____ shed

____ kitchen
____ bathroom/outhouse
____ 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
[_] TV Guide
[_] Rifle and Shotgun

[_] The Globe
[_] Soap Opera Digest
[_] 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


___ Do you hunt Bear? If so, please do not explain


How often do you bathe:
[_] Weekly
[_] Monthly
[_] Not Applicable


How many teeth in YOUR mouth?___


Color of teeth:
[_] Yellow
[_] Brown

[_] Brownish-Yellow
[_] 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


Distance between mobile home and Bubba's House of Beer?


How many times has you received a DWI this year?____