West Virginia Residency Application

     STATE OF WEST VIRGINIA RESIDENCY APPLICATION

     Last Name: ________________

     First name:  (Check appropriate box):

     (_) Billy-Bob
     (_) Billy-Joe
     (_) Billy-Ray
     (_) Billy-Sue
     (_) Billy-Mae
     (_) Billy-Jack
     (_) Billy

     Age: ____, if known
     Sex: ____ M _____ F _____ N/A
     Shoe Size: ____ Left ____ Right

     Occupation: (phonetic spellings available)
     (_) Farmer
     (_) Mechanic
     (_) Hair Dresser
     (_) Un-employed

     Spouse's Name: __________________________

     Relationship with spouse:
     (_) Sister
     (_) Brother
     (_) Aunt
     (_) Uncle
     (_) Cousin
     (_) Mother
     (_) Father
     (_) Son
     (_) Daughter
     (_) Pet
     (_) Livestock

     Number of children living in household (If you can count) : ___
     Number that are yours: ___

     Mother's Name: _______________________

     Father's Name: _______________________ (If not sure, leave blank)
     Relation of mother to father: _________________
     Education: 1 2 3 4 (Circle highest grade completed)

     Do you (_)own or (_)rent your mobile home?  (Check appropriate box)
     Does it have wheels? (_)
     How many tornadoes has it been through? (_)

     ___ 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

     Number of shirts you own. (1.. 2)
     Number of shirts that are tank tops with motorcycles on them(_)

     What does your foam hat say?
     (_) John Deer
     (_) If I have anything to say to you I'll fart
     (_) I own a chevy truck
     (_) Old Fart's Wife
     (_) No longer readable due to filth
     (_) you don't know because you can't read

     Firearms you own and where you keep them:
     ____ truck
     ____ bedroom
     ____ bathroom
     ____ kitchen
     ____ shed
     ____ church benches ( for when father speaks of the sins of incest)

     Model and year of your pickup: _____________ 194_
     How many deer have you struck with it? (_)

     Do you have a gun rack?
     (_) Yes (_) No; please explain:

     Have you been struck by lightning? (_) How many times? (_)
     While carrying a firearm? (_)

     What flavors of aqua velva does the local bar serve on tap?
     (_) springtime blue
     (_) musk
     (_) seaside green

     How many of your family members are cross eyed? (__), (_)all.

     Newspapers/magazines you subscribe to:
     (_) The National Enquirer
     (_) Hustler
     (_) soldier of fortune
     (_) TV Guide
     (_) Soap Opera Digest
     (_) Rifle and Shotgun

     ___ 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
     ___ Number of times you've shot at Elvis in a UFO
     ___ Number of consecutive sober days (0,1,2,3, can't remember)

     Do you bathe? (_)

     If so, how often do you bathe:
     (_)Weekly
     (_)Monthly
     (_)Not Applicable

     Color of teeth:
     (_)Yellow
     (_)Brownish-Yellow
     (_)Brown
     (_)Black
     (_)No teeth

     Brand of chewing tobacco you prefer:
     (_)Red-Man

     How far is your home from a paved road?
     (_)1 mile
     (_)2 miles
     (_)don't know