ARKANSAS STATE RESIDENCY APPLICATION

Name: ________________
(_) Billy-Bob (last)
(_) 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: (check the one that applies)
(_)Farmer
(_)Mechanic
(_)Hair Dresser
(_)Un-employed

Spouse's Name: __________________________
Relationship with spouse <IMG SRC="smilies/yelsad.gif" border="0">check the one that applies)
(_) 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 ___

Firearms you own and where you keep them:
truck ____
bedroom ____
bathroom ____
kitchen ____
shed

Model and year of your pickup: Model:___________ Year: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

Not Applicable 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