The Loony Bin
(
loonies@bloodaxe.demon.co.uk
)
Mon, 21 Oct 1996 01:47:23 +0100
Hiya All...
Another application form...
Wishes & Dreams...
- ANDREA
xx
*************<andrea@bloodaxe.demon.co.uk>*************
*****<ajc6@ukc.ac.uk>*****<bloodaxe@geocities.com>*****
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*******************Internet Goddess********************
**********************ANDROMEDA************************
------- Forwarded foolishness follows -------
ALABAMA STATE RESIDENCY APPLICATION
Name: ____________ (_) Billy-Bob
(last) (_) 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
(_)Asbestos Worker
(_)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_
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
Organizations that you belong to: (Check all that are applicable)
(_) NRA
(_) PTL
(_) 700 Club
(_) KKK
(_) NHRA
Number of tractor pulls you've been to this month :
(_) <5 (_) 5-10 (_) 11-15
(_) Can't count
Beverage of choice:
(_) Night Train
(_) Blind Dog Bourbon
(_) Cousin Cletus' Moonshine (Non-Commercial)
(_) Gasoline
Number of Skoal Belt Buckles You Own:____
Brand of Jeans you prefer:
(_) Wranglers
Do you play the banjo? (_) Yes