ARKANSAS STATE RESIDENCY APPLICATION

Name:
(_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(_) Billy-Jefferson (Check appropriate box)


Age: ____
Sex: ____ M _____ F _____ N/A


Shoe Size: ____ Left ____ Right


Occupation:
(_)Farmer
(_)Mechanic
(_)Hair Dresser
(_)Unemployed


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