Arkansas State Residency Application

[Guest guest]

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 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 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