[smoke gets in my eyes]

Kentucky: Five Million People; Fifteen Last Names
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STATE OF KENTUCKY 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