State of Arkansas
  
                         Bill Clinton Governor
  
                    APPLICATION TO LIVE IN ARKANSAS
  
  
  
  Name:_______________________________________________________________________
  
  Nickname:_______________________________  CB Handle:__________________________
  
  Address
  (RFD)________________________________________________________________
  
  Daddy (if unknown, list of 3 suspects)
  ______________________________________
  
  Neck: () Lt Red   ()Med 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 man cars/wrecks in front yard?______ On How Many 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? (not boots) () YES   () NO
  
  Are you married to any of the following (Check all that apply):
  
  ()Sister  ()Cousin  ()Cousin's Sister  ()Aunt
  ()Other____________________
  
  Does your wife weigh more than your pickup?  ()YES  () NO
  
  Can you sign your own 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  () Tatoos  () Crossed Eyes
  
   () Runny Nose  () Green Teeth  ()Brown Teeth  ()Yellow Teeth  ()Any Teeth
    
   () Number of Teeth Missing __________
 
  GENERAL INFORMATION
 
  Can you count past ten with your shoes on?  () YES   ()NO
  
  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  () Rebel Flag
  
                       () Roll Bar  () CB Radio  () Beer Cans  () Squirrel
   								  Tail
  
  Favorite Vocalist:   ()Willie Nelson  ()Johnny Cash  ()Elvis 
 		       ()Conway Twitty   ()L. Lynn
  
  Bumper Stickers:     () Honk If You Love Jesus  () Dial 1-800-EAT-SHIT
  
                       () Old Fart                () Dig Clams
  
  Cap Emblems:         () John Deere  ()CAT  ()SKOAL  ()Budweiser  () Jack Daniels
  
  Memberships:         () NRA  ()VFW  ()KKK  ()700 CLUB
  
  
  
  Your signature (one X will do):_________________________________
  Date:______