Last name: ________________

First name: (Check appropriate box)

What does everyone call you?

Age: ____ (if unsure, guess)>

Sex: ____ M _____ F _____ Not sure>

Shoe Size: ____ Left ____ Right>

Occupation: (Check appropriate box)

Spouse’s Name:_________________________>

2^nd Spouse’s Name:______________________>

3^rd Spouse’s Name:______________________>

Lover’s Name:___________________________

Relationship with current spouse: (Check appropriate box)

Number of children living in household: _____>

Number of children living in shed: ______>

Number that are yours: ______>

Mother’s Name: _______________________(If not > sure, leave blank)>

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)>

Firearms you own and where you keep them:

Model and year of your pickup: 196_>

Do you have a gun rack?

(_) Yes (_) No; If no, please explain:

Newspapers/magazines you subscribe to:

Number of times you’ve seen a UFO:_____>

Number of times in the last 5 years you’ve seen > Elvis:_____>

Number of times you’ve seen Elvis in a UFO:_____>

How often do you bathe:

Color of eyes:

Left______ Right_____

Color of hair:

Color of teeth:

Brand of chewing tobacco you prefer:

How far is your home from a paved road?