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[etmuse]

ARKANSAS STATE RESIDENCY APPLICATION

Name: [ ]  ________________________
        [ ] Billy-Bob
[ ] Billy-Joe
[ ] Billy-Ray
[ ] Billy-Sue
[ ] Billy-Mae
[ ] Billy-Jack
[ ] Billy-Jefferson
(Check appropriate box)

Age: ______

Sex: [ ] M [ ] F     [ ] N/A

Shoe size: Left ________    Right ________

Occupation:
[ ] Farmer
[ ] Mechanic
[ ] Hairdresser
[ ] Unemployed

Spouse’s Name: _____________________

Relationship with spouse:
[ ] Sister
[ ] Brother
[ ] Aunt
[ ] Uncle
[ ] Cousin
[ ] Mother
[ ] Father
[ ] Son
[ ] Daughter
[ ] Pet

Number of children in household: ______
Number that are yours: ______

Mother’s Name: _________________
Father’s Name: __________________ (if unknown leave blank)

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

Do you [ ] own    [ ] rent  your mobile home

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 firearms you keep in your…
truck: ____
bedroom: ____
        bathroom: ____
        kitchen: ____
        shed: ____


Model and year of your pickup: ___________, 194_

Newspapers/magazines you subscribe to:
[ ] The National Enquirer
[ ] The Globe
[ ] TV Guide
[ ] Soap Opera 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
[ ] N/A

Color of teeth:
[ ] Yellow
[ ] Brownish-yellow
[ ] Brown
[ ] Black
[ ] 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

[rockchick]

(ancient graphic designer)