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!
			



