State of Arkansas
Bill Clinton, Governor
APPLICATION TO LIVE IN ARKANSAS

Name: _______________________________________________________________________

Nickname: _____________________________ CB Handle: __________________________

Address (RFD): ______________________________________________________________

Daddy (if unknown, attach a list of 3 suspects): ____________________________

NECK SHADE: ( ) Light Red ( ) Medium Red ( ) Dark Red ( ) Other

Number of teeth exposed in full grin: ____________Upper ____________ Lower

Make of Pickup: _______________________ Size of tire: _______________________

HOUNDS: ________ TYPE: ( ) Blue Tick ( ) Beagle ( ) Black & Tan ( ) Other

Length of right leg: _______ Length of left leg: _______ Other: ________

How many cars/makes in front yard? __________ How many on blocks? __________

How many kitchen appliances on front porch? __________ Back porch? _________

When and where was your last "Elvis" sighting? ______________________________

Do you wear mostly polyester pants with snags? ( ) Yes ( ) No

Do you own any shoes (or boots)? ( ) Yes ( ) No

Are you married to any of the following (circle all that apply):
( ) Sister ( ) Cousin ( ) Cousin's Sister
( ) Aunt ( ) Other (explain): ________________________________

Does your wife weigh more than your pickup? ( ) Yes ( ) No

Can you sign your name and always spell it right? ( ) Yes ( ) No

Have you EVER had more than one bath in a week? ( ) Yes ( ) No

MEDICAL INFORMATION:
Do you have at least two (2) of the following: ( ) B.O. ( ) Crabs
( ) Lice ( ) Bad Breath ( ) Scabies ( ) Fleas
( ) Tattoos ( ) Crossed Eyes ( ) Runny Nose ( ) Green Teeth
( ) Brown Teeth ( ) Yellow Teeth ( ) Any Teeth
Number of teeth missing? _______________________________________________

GENERAL INFORMATION:
Can you count past 10 with your shoes on? ( ) Yes ( ) No
Can you count past 21 with your fly up? ( ) Yes ( ) No

Favorite weapon: ( ) Tire Iron ( ) Pick Handle ( ) Log Chain ( ) Shotgun

Favorite pastime: ( ) Drinkin' ( ) Coon Huntin' ( ) Fishin' ( ) Other

Truck equipped with: ( ) Gun Rack ( ) Fuzzbuster ( ) 8-track ( ) C.B.
( ) Rebel Flag ( ) Roll Bar ( ) Beer Cans ( ) Squirrel Tail

Favorite Vocalist: ( ) Willie Nelson ( ) Johnny Cash ( ) Elvis
( ) Conway Twitty ( ) Loretta Lynn ( ) Johnny Paycheck

Bumper Stickers: ( ) Honk if you love Jesus ( ) Dial 1-800-EAT-SHIT
( ) Old Fart ( ) Dig Clams

Cap Emblems: ( ) John Deere ( ) CAT ( ) Skoal ( ) Budweiser

Memberships: ( ) 700 Club ( ) VFW ( ) NRA ( ) B.P.O.E.

Your signature (one X will do): _____________________ Date: _________________