Arkansas Residency Application

State of Arkansas Residency Application

Name: ................ (last)
( ) Billy-Bob
( ) 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_
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