APPLICATION TO LIVE IN ARKANSAS
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State of Arkansas                               Bill Clinton, Governor



Name:                             Nickname:                       
CB Handle:                        Address(RFD):                   
Daddy (If unknown, attach list of 3 suspects):                    
NECK SHADE:  []Light Red   []Medium Red   []Dark Red   []Other
Number of teeth exposed in full grin:    Upper      Lower
Truck equipped with: []Gun Rack  []Fuzzbuster  []8 Track  []Roll Bar
                     []CB Radio  []Beer Cans   []Squirrel Tail
Number of Hounds:   Type: []Blue Tick  []Beagle  []Black & Tan  []Other
Length of Right Leg:     Length of Left Leg:     Other:   
How many cars/makes parked in front yard?   How many on blocks?  
How many kitchen appliances on front porch?    Back porch?   
When and where was your last "ELVIS" sighting?                    
Do you wear polyester pants with sags?   []Yes   []No
Do you own any shoes (not boots)?        []Yes   []No
Are you married to any of the folowing (Circle all that apply)?
  []Sister  []Cousin  []Cousin's Sister  []Aunt  []Other               
Does your wife weigh more than your pickup?            []Yes   []No
Can you sign your own name and always spell it right?  []Yes   []No
Have you EVER had more than one bath in a week?        []Yes   []No
If Yes, please explain                                                 
                                                                       



MEDICAL INFORMATION:
Do you have at least two (2) of the following: []B.O.   []Crabs
 []Lice  []Fleas []Bad Breath   []Scabies      []Tatoos   []Crossed Eyes
 []Gold Teeth    []Green Teeth  []Brown Teeth  []Yellow Teeth
# of Teeth Missing?    



GENERAL INFORMATION:
Can you count past 10 with your shoes on?     []Yes   []No
Past 21 with your fly up?                     []Yes   []No
Favorite Weapon: []Tire Iron  []Pick Handle  []Log Chain  []Shotgun
Favorite Pastime: []Drinkin'  []Coon Huntin'  []Fishin'  []Other
Favorite Vocalist:[]Willie Nelson []Elvis []Johnny Cash []Loretta Lynn
Bumper Sticker: []Honk if you love Jesus  []Dial 1-800-EAT-SHIT
                []Old Fart                []E.T. Phone Home
Cap Emblems: []JOHN DEERE []CAT []SKOAL []BUDWEISER []JACK DANIELS
Membership:  []NRA  []VFW  []KKK  []700 CLUB  []B.P.O.E.



Signature (one X will do):                              Date: