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


How far is your home from a roadsign WITHOUT bulletholes ?

[_] 1 state (or in the same state)
[_] 2-5 states
[_] 5 or more states

How many diferent trucks does the parts in your truck come from?

[_] 10 or less
[_] 11-25
[_] 25-50
[_] 50 or more

How many of the lamps on the truck's dashboard actually works?

[_] None
[_] 1-2
[_] Depends on the air humidity
[_] All / most of them works, but they blink like a christmas tree

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