ARKANSAS STATE RESIDENCY APPLICATION

ARKANSAS STATE RESIDENCY APPLICATION
Name: ________________
(_) Billy-Bob (last)
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(_) Billy-Jefferson
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right
Occupation:
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Un-employed
Spouse's Name: __________________________
Relationship to 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_
Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
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!
Name: ________________
(_) Billy-Bob (last)
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(_) Billy-Jefferson
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right
Occupation:
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Un-employed
Spouse's Name: __________________________
Relationship to 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_
Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
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!