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Name:	HubCap -	Reply
Subject:	Arkansas Residency Application
Date:	3/28/2011 4:11:32 AM

Arkansas Residency Application Last Name: ________________ (last) First Name: (Check appropriate box) (_) Billy-Joe (_) Billy-Ray (_) Billy-Sue (_) Billy-Mae (_) Billy-Jack 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? ___ 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

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