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 [_] Badd-Teddy Bob 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: _______________________ (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 ____ 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 ___ 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 [_] 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 Distance between mobile home and Bubba's House of Beer ?_____ How many times has you received a DWI this year?____

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