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State of Arkansas Residency Application
Name: ________________ (_) Billy-Bob
(last) (_) Billy-Joe
(Check appropriate box)
Sex: ____ M _____ F _____ N/A
Shoe Size ____ Left ____ Right
(_) Hair Dresser
Spouse's Name: __________________________
Relationship with spouse:
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
Do you (_)own or (_)rent your mobile home?
___ 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:
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:
Color of teeth:
Brand of chewing tobacco you prefer:
How far is your home from a paved road?
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