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of
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Last name:
_
First name: (Check appropriate box)
Billy-Bob [J Bobby-Sue
Billy-Joe [J Bobby-Jo
[ 1 Billy-Ray [_] Bobby-Ann
Billy-Sue [J Bobby-Lee
Billy-Mae [J Bobby-Ellen
Billy-Jack [J Bobby-Beth
Age:
Sex:
SEMES
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Umbrella"
(If unsure, guess.)
M F
Not sure
Shoe Size:
Left
Right
Occupation:
Farmer [ ] Mechanic
Hair Dresser [J Waitress
Unemployed [ ] Dirty Politician
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Education: 1 2 3 4 (Circle highest grade completed.)
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Do you [_] own or [_J rent your mobile home?
(Check appropriate box.)
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Total number of vehicles you own.
Number of vehicles that still crank.
Number of vehicles in front yard.
Number ol vehicles in back yard.
Number of vehicles on cement blocks.
Where you keep them firearms:
truck
kitchen
FOF SALE
“B r o t h e r ” W o r
bedroom bathroom
shed
Model and year of your pickup:
194
P r o c e s s o r
o t h H4" M o n it o r .
U s e d o n l y
’
HO h o u r s ? L u k e M e w = r
MANY OPTIONS.
Do you have a gun rack?
Yes U No
If no, please explain:
Newspapers/magazines you read:
The National Enquirer [J The Globe
[J TV Guide [JSoap Opera Digest
Rifle and Shot-gun
d
^250.00
©(55-33HO
Color of tooth:
Yellow
Brownish-Yellow
Brown [J Black
N/A
Number of times you've seen a UFO
Brand of chewing tobacco you prefer:
Number of times you've seen Elvis
Red-Man
Number of times you've seen Elvis in a UFO
How far is your home from a paved road?
1 mile
How often do you bathe:
2
miles
Weekly
don't know
[ ] Monthly
paved road? ponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Not Applicable
II