S
stefen
Guest
State Residency Application
Name: ________________
(last)
(first) (_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right
CB Handle: _____________________
Occupation:
(_)Farmer
(_)Mechanic
(_)Hair Dresser
(_)Un-employed
(_)Coal Miner
Spouse's Name: __________________________
Relationship with spouse:
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet
Number of children living in household: ___
Number that are yours: ___
Mother's Name: _______________________
Father's Name: _______________________
(If not sure, leave blank)
Education: 1 2 3 4 (Circle highest grade completed)
Do you (_)own or (_)rent your mobile home?
(Check appropriate box)
___ 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
___ Number of refrigerators on front porch
Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed
Model and year of your pickup: _____________ 194__
Number of empty beer cans on floorboard or in bed of
pickup: _________
Newspapers/magazines you subscribe to:
(_)The National Enquirer
(_)The Globe
(_)TV Guide
(_)Soap Opera Digest
(_)Gun World
___ 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
(_)Holidays
(_)Not Applicable
Color of teeth:
(_)Yellow
(_)Brownish-Yellow
(_)Brown
(_)Black
(_)No teeth
(_)N/A
Brand of chewing tobacco you prefer:
(_)Red-Man
How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)don't know
(_)can't get there from here
BUMPER STICKERS:
___ Eat more Possum
___ My other car is a piece of junk too
___ Honk if you love Jesus
___ If you ain't a cowboy, you ain't nothin'
___ Red-man Chewing Tobacco
Favorite Recreation: Check all that apply:
___ Square Dancin'
___ Possum Huntin'
___ Skinny Dippin'
___ Craw Daddin'
___ Gospel Singin'
___ 4-Wheelin'
___ Drankin'
___ Spittin' Backy ___ Bill Chip Trowin'
___ Honky Tonkin'
___ Noodlin'
# of Dogs: ___ Type: ___ Blue Tick ___ Beagle
___ Black & Tan ___ Bird Dawg
Cap Emblem: ___ John Deere ___ McCulloch Chain Saws
___ Budweiser ___ Vo-Tech
___ Skoal ___ Coors
___ NAPA ___ Smile if you're Not Wearing Underwear
Name: ________________
(last)
(first) (_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right
CB Handle: _____________________
Occupation:
(_)Farmer
(_)Mechanic
(_)Hair Dresser
(_)Un-employed
(_)Coal Miner
Spouse's Name: __________________________
Relationship with spouse:
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet
Number of children living in household: ___
Number that are yours: ___
Mother's Name: _______________________
Father's Name: _______________________
(If not sure, leave blank)
Education: 1 2 3 4 (Circle highest grade completed)
Do you (_)own or (_)rent your mobile home?
(Check appropriate box)
___ 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
___ Number of refrigerators on front porch
Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed
Model and year of your pickup: _____________ 194__
Number of empty beer cans on floorboard or in bed of
pickup: _________
Newspapers/magazines you subscribe to:
(_)The National Enquirer
(_)The Globe
(_)TV Guide
(_)Soap Opera Digest
(_)Gun World
___ 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
(_)Holidays
(_)Not Applicable
Color of teeth:
(_)Yellow
(_)Brownish-Yellow
(_)Brown
(_)Black
(_)No teeth
(_)N/A
Brand of chewing tobacco you prefer:
(_)Red-Man
How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)don't know
(_)can't get there from here
BUMPER STICKERS:
___ Eat more Possum
___ My other car is a piece of junk too
___ Honk if you love Jesus
___ If you ain't a cowboy, you ain't nothin'
___ Red-man Chewing Tobacco
Favorite Recreation: Check all that apply:
___ Square Dancin'
___ Possum Huntin'
___ Skinny Dippin'
___ Craw Daddin'
___ Gospel Singin'
___ 4-Wheelin'
___ Drankin'
___ Spittin' Backy ___ Bill Chip Trowin'
___ Honky Tonkin'
___ Noodlin'
# of Dogs: ___ Type: ___ Blue Tick ___ Beagle
___ Black & Tan ___ Bird Dawg
Cap Emblem: ___ John Deere ___ McCulloch Chain Saws
___ Budweiser ___ Vo-Tech
___ Skoal ___ Coors
___ NAPA ___ Smile if you're Not Wearing Underwear
