State of Arkansas Residency Application

Last Name:  _______________________________________________________

First Name:  (Check appropriate box)
     * Billy-Bob
     * Billy-Joe
     * Billy-Ray
     * Billy-Sue
     * Billy-Mae
     * Billy-Jack

Age:  _______      Sex:  * Male     * Female          * 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 or list three suspects)

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

Do you own or rent your mobile home?  _____________________________

Is it on blocks or original tires?  _______________________________

Neck Shade:  * Light Red          * Medium Red          * Dark Red

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
     ____  Other ______________

Model and year of your pickup:  _____________________________  194_

Truck equipped with:  (Check all that apply)
     * Gun rack
     * Fuzz buster
     * Air Horns
     * Mag Wheels
     * 8-track
     * Load of wood
     * Hi-jacker shocks
     * Mud grip tires
     * 4-Wheel Drive
     * Toothpick Holder
     * Dual CB antenna
     * Raccoon hide
     * Spittoon
     * Camper top
     * Confederate Flag
     * Big dog
     * Deer rack on front radiator

Number of empty beer cans on floor of pickup:  __________________

Bumper stickers:
     * Eat More Possum
     * Honk If You Love Jesus
     * Wave If You're Horny
     * Red Man Chewing Tobacco

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

Brand of chewing tobacco you prefer:     * Red-Man

How far is your home from a paved road?
     * 1 mile
     * 2 miles
     * Don't know

Cap Emblem:
     * John Deere
     * CAT
     * Budweiser
     * NAPA
     * Coors
     * Toro
     * McCulloch Chain Saws

Memberships:
     * KKK
     * NRA
     * Moose
     * PTL Club
     * VFW
     * Bassmasters
     * American Legion
     * United Sons/Daughters of the Confederacy

Can you count past 10 with your shoes on, fly zipped and shirt on?