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
Model and year of your pickup: _____________ 194_
Truck equipped with:
____gun rack____fuzz buster____8-track
____Roll bar____beer cans____squirrel tail
____CB radio____rebel flag____centrefold pic
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____________
When was your last Elvis sighting?____________________
How often do you bathe:
(_)Weekly
(_)Monthly
(_)Not Applicable
Color of teeth:
(_)Yellow
(_)Brownish-Yellow
(_)Brown
(_)Black
(_)N/A
Number of teeth exposed in full grin:
_____Upper:_____Lower:_____
Brand of chewing tobacco you prefer:
(_)Red-Man
(_)Skoal's
How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)don't know
Neck:___Light red___Medium red___Dark red
Hounds/Type:
Bluetick____Beagle____Black & Tan____Other________
Length of right leg:_____Length of left leg_______
How many kitchen appliances?:
___On front porch ___On back porch
Do you wear mostly polyester pants? Yes____No_____
Do you have any shoes? (no boots) Yes____No_____
Do you have any of the following:
B.O.__ Crabs__ Bad Breath__ Lice__ Scabies ___Fleas____
Crossed Eyes___ Runny Nose__ Tattoos___
Can you count past 10 with your shoes on? Yes____No____
Can you count past 21 with your fly up? Yes____No____
Favourite weapon:
___tire iron ___pick handle ___chain saw ___shot gun
Favourite pastime:
___drinkin ___coon huntin ___fishin ___other
Favourite singer:
___Willie Nelson ___Johnny Cash ___Conway Twitty ___Elvis
Bumper stickers:
___Honk If You Love Jesus
___Dial 1-800-EAT-SHIT
___OLD FART
Cap Emblems:
___John Deere ___Skoal ___Budweiser ___Cat
___Jack Daniels ___Southern Comfort
Memberships:
___NRA ___ VFW ___KKK ___700 CLUB ___B.P.O.E.
Favourite movie is DELIVERANCE ___Yes ___No
Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed
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