þ#&]%%+f¥ ! )19AI ÿ‹‚APPLICATION TO LIVE IN ARKANSAS Name:_______________________________________________________ Nickname:________________, CB Handle________________________ Address (RFD):___________ Daddy (if unknown, attach list of 3 suspects):______________ ____________________________________________________________ ‚ ‚ PERSONAL: Neck shade: ( )Light Red ( )Medium Red ( )Dark Red ( )Other Number of teeth exposed in full grin:____Upper:____Lower____ Make of pickup:______________Size of tire:__________________ # of Hounds:____Type: ( )Blue Tick ( )Beagle ( )Black & Tan How many cars/makes in fronts yard?_________________________ How many on blocks?____ How many kitchen appliances on front porch?___Back porch?___ When and where was your last "Elvis" sighting?_____________ Do you own any shoes (please do not count boots)? ()Yes ()No Are you married to any of the following? (Circle all that apply): ()Sister ()Cousin ()Aunt ()Other,explain_________ Does your wife weigh more than your pickup? ()Yes ()No How many children do you have?___(estimate) Have you ever had more than one bath in a week? ()Yes ()No MEDICAL INFORMATION: Do you have at least (2) of the following: ()B.O. ()Crabs ()Bad Breath ()Fleas ()Tattoos ()Runny nose ()Brown Teeth ()Yellow Teeth ()Any Teeth ()# of Teeth Missing? ƒ GENERAL INFORMATION Favorite weapon: ()Tire Iron ()Pick Handle ()Log Chain Favorite pastime: ()Drinkin ()Coon Huntin' ()Fishin' ()Other Truck equipped with: ()Gun Rack ()Fuzz Buster ()8-Track ()Rebel Flag ()Roll Bar ()C.B. Radio ()Beer Cans Favorite vocalist: ()Willie Nelson () Johnny Cash ()Conway Twitty ()Loretta Lynn ()What's a vocalist!? # of Hats:___ Hat Emblems: ()John Deere ()CAT ()SKOAL Membership: ()NRA ()VFW ()KKK ()700 Club ()BPOE In the brackets provided to the right please tell us anything else you would like us to know about yourself in this application: { } YOUR SIGNATURE (ONE X WILL DO) _______________ DATE_________