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                   ARKANSAS STATE 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_

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

 ___ 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