First name: ______________________



Last name(if known):______________







Address (where you live):_________



__________________________________











Mother's name_____________________



      (also relation, i.e., sister)







Birthdate(yours):__________________







Father's name:_____________________



   (if known, if not, list choices)







Color of neck:



          Light Red ( )



          Medium Red( )



          Dark Red  ( )



          No Neck   ( )







Year of pickup truck:_____________







List all that you have in your truck:







Fuzzy Dice( ) Gun Rack( ) Coon Tail( )



Filled ash tray( )  Dead Road Kill( )



Dog of Unknown Breed( )







Have you ever been to a large city?



(Like Little Rock) Yes ( ) No ( )











How far can you throw cow pies?____



Do you eat cow pies? Yes( ) No( )







Wife's name:__________________



Is she: Cousin( ) Neighbor( )



Sister( ) Aunt ( ) Mother( )



Neighbor's dog( )







Does your wife weigh:



Less than 200 Pounds( )



Less than 300 Pounds( )



Less than a 747( )



More than a 747( )







Do you know what a 747 is?



Yes( ) No( )







How much smarter than you



is your wife:







50 IQ Points( ) 75 IQ Points( )



100 IQ Points( ) She Won't Tell Me( )







Does your wife wear:







A Dress( ) Pants( ) Hot Pants( )  



Your Pants( ) Them Lawyer Clothes( )



Nothing( )







Understood previous questions:







Yes( )  No( ) Huh?( )



All of the Above( )



What "previous" mean?( )







Color of wife's hair:







Blonde( ) Red( ) Brown( )



Black( ) Bald( )







Last Elvis sighting:



Location: ________________



On what date?_____________







Can you count past five:



Yes( ) No( )  Past ten: Yes( ) No( )







Explain in ten words or less



why on Earth you want to be Governor 



of Arkansas:







________________________________



Signature ('X' if you can't write)