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                             State of Arkansas
                                      
                           Residency Application
     
   
   Name: ________________  (_) Billy-Bob
             (last)        (_) Billy-Joe
                           (_) Billy-Ray
                           (_) Billy-Sue
                           (_) Billy-Mae
                           (_) Billy-Jack
                           (Check appropriate box)

   Age: ____
   Sex: ____ M _____ F _____ N/A
   Shoe Size: ____ Left ____ Right

   Occupation:
   (_) Farmer
   (_) Mechanic
   (_) Hair Dresser
   (_) Un-employed

   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

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

   Model and year of your pickup: _____________ 194_

   Do you have a gun rack?
   (_) Yes (_) No; please explain:



   Newspapers/magazines you subscribe to:
   (_) The National Enquirer
   (_) The Globe
   (_) TV Guide
   (_) Soap Opera Digest
   (_) Rifle and Shotgun

   ___ 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
  





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