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 SizeLeft 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 spouseCheck all that apply. Sister Aunt Brother Uncle Mother Son Father Daughter Cousin Number of children living in household: Number of children living in shed: Number of children that are yours: Mother's Name: Father's Name: (If not sure, leave blank) Education:(Check highest grade completed) 1 2 3 4 Do you own or rent your mobile home? (Check appropriate box) 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 Firearms you own and where you keep them: truck kitchen bedroom bathroom shed Model and year of your pickup 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 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 Mutual Fund Digest 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? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Color of teeth: Yellow Brownish-Yellow Brown Black N/A Brand of chewing tobacco you prefer Red-Man Skoal How far is your mobile-home from a paved road? 1 mile 2 miles don't know
First name(Check appropriate box)
Age(if unsure, guess)
Sex
Shoe SizeLeft Right
Occupation
Spouse's Name: 2nd Spouse's Name: 3rd Spouse's Name: Lover's Name: 2nd Lover's Name:
Relationship with spouseCheck all that apply.
Number of children living in household: Number of children living in shed: Number of children that are yours:
Mother's Name: Father's Name: (If not sure, leave blank)
Education:(Check highest grade completed)
Do you own or rent your mobile home? (Check appropriate box)
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
Firearms you own and where you keep them: truck kitchen bedroom bathroom shed
Model and year of your pickup 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949
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 Mutual Fund Digest
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? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Color of teeth: Yellow Brownish-Yellow Brown Black N/A
Brand of chewing tobacco you prefer Red-Man Skoal
How far is your mobile-home from a paved road? 1 mile 2 miles don't know