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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?



___ 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