Arkansas State Residency Application

Name: ________________ (_) Billy-Bob(last) (_) Billy-Joe(_) Billy-Ray(_) Billy-Sue(_) Billy-Mae(_) Billy-Jack(_) Billy-Jefferson(Check appropriate box)Age: ____Sex: ____ M _____ F _____ N/AShoe Size: ____ Left ____ RightOccupation:(_)Farmer(_)Mechanic(_)Hair Dresser(_)Un-employedSpouse's Name: __________________________Relationship with spouse:(_) Sister(_) Brother(_) Aunt(_) Uncle(_) Cousin(_) Mother(_) Father(_) Son(_) Daughter(_) PetNumber 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 blocksFirearms you own and where you keep them:____ truck____ bedroom____ bathroom____ kitchen____ shedModel 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 UFOHow often do you bathe:(_)Weekly(_)Monthly(_)Not ApplicableColor of teeth:(_)Yellow(_)Brownish-Yellow(_)Brown(_)Black(_)N/ABrand of chewing tobacco you prefer:(_)Red-ManHow far is your home from a paved road?(_)1 mile(_)2 miles(_)don't know