First name: ______________________
Last name(if known):______________

Address (where you live):_________
__________________________________


Mother's name_____________________
      (also relation, i.e., sister)

Birthdate(yours):__________________

Father's name:_____________________
   (if known, if not, list choices)

Color of neck:
          Light Red ( )
          Medium Red( )
          Dark Red  ( )
          No Neck   ( )

Year of pickup truck:_____________

List all that you have in your truck:

Fuzzy Dice( ) Gun Rack( ) Coon Tail( )
Filled ash tray( )  Dead Road Kill( )
Dog of Unknown Breed( )

Have you ever been to a large city?
(Like Little Rock) Yes ( ) No ( )


How far can you throw cow pies?____
Do you eat cow pies? Yes( ) No( )

Wife's name:__________________
Is she: Cousin( ) Neighbor( )
Sister( ) Aunt ( ) Mother( )
Neighbor's dog( )

Does your wife weigh:
Less than 200 Pounds( )
Less than 300 Pounds( )
Less than a 747( )
More than a 747( )

Do you know what a 747 is?
Yes( ) No( )

How much smarter than you
is your wife:

50 IQ Points( ) 75 IQ Points( )
100 IQ Points( ) She Won't Tell Me( )

Does your wife wear:

A Dress( ) Pants( ) Hot Pants( )  
Your Pants( ) Them Lawyer Clothes( )
Nothing( )

Understood previous questions:

Yes( )  No( ) Huh?( )
All of the Above( )
What "previous" mean?( )

Color of wife's hair:

Blonde( ) Red( ) Brown( )
Black( ) Bald( )

Last Elvis sighting:
Location: ________________
On what date?_____________

Can you count past five:
Yes( ) No( )  Past ten: Yes( ) No( )

Explain in ten words or less
why on Earth you want to be Governor 
of Arkansas:

________________________________
Signature ('X' if you can't write)