Last name: _________________

First name:

(Check appropriate box)

[_] 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_____Not sure



Shoe Size: _____Left_____Right



Occupation:

[_] Farmer [_] Mechanic

[_] Hair Dresser [_] Waitress

[_] Unemployed [_] Dirty Politician



Spouses Name_________________________

2nd Spouses Name: _________________

3rd Spouses Name: _________________



Lovers Name: ________________________

2nd Lovers Name: ___________________



Relationship to spouse:

[_] Sister [_] Aunt

[_] Brother [_] Uncle

[_] Mother [_] Son

[_] Father [_] Daughter

[_] Cousin [_] Pet



Number of children living in household: _____

Number of children living in shed: _____

Number that are yours: _____



Mothers Name: ___________________

Fathers Name: ___________________ (If not sure, leave blank)



Education: 1 2 3 4 (Circle highest grade completed)



Do you [_] own or [_] rent your mobile home?

___ Total number of vehicles that 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



Where your firearms are kept:

[_] truck [_] kitchen

[_] bedroom [_] bathroom

[_] shed



Model and year of your pickup: _______ 194_



Do you have a gun rack?

[_] Yes [_] No; if no, please explain:

_____________________



Newspapers/magazines you subscribe to:

[_] National Enquirer [_] The Globe

[_] TV Guide [_] Soap Opera Digest

[_] Rifle and Shotgun



___ Number of times youve seen a UFO

___ Number of times youve seen Elvis

___ Number of times youve seen Elvis in a UFO



How often do you bathe:

[_] Weekly

[_] Monthly

[_] Not applicable



Color of teeth:

[_] Yellow [_] Brownish-Yellow

[_] Brown [_] Black

[_] N/A

How many?_____



Brand of chewing tobacco you prefer: [_] Red-Man



How far is your home from a paved road?

[_] 200-400 miles

[_] over 400 miles

[_] whats a miles?