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  1. #11
    Bad address email on file k12311997's Avatar
    Join Date
    Feb 2005
    Location
    PA
    Occupation
    Dispensing Optician
    Posts
    1,921
    West Virginia State Residency Application
    Name: ________________
    (last)
    (first)
    (_) Billy-Bob
    (_) Billy-Joe
    (_) Billy-Ray
    (_) Billy-Sue
    (_) Billy-Mae
    (_) Billy-Jack
    (Check appropriate box)
    Age: ____Sex: ____ M _____ F _____ N/A
    Shoe Size: ____ Left ____ Right
    CB Handle: _____________________
    Occupation(_)Farmer(_)Mechanic(_)Hair Dresser(_)Un-employed(_)Coal Miner

    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
    ___ Number of refrigerators on front porch
    Firearms you own and where you keep them:____ truck____ bedroom____ bathroom____ kitchen____ shed
    Model and year of your pickup: _____________
    Number of empty beer cans on floorboard or in bed ofpickup: ________
    Newspapers/magazines you subscribe to:
    (_)The National Enquirer
    (_)The Globe
    (_)TV Guide
    (_)Soap Opera Digest
    (_)Gun World
    ___ 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
    (_)Holidays
    (_)Not Applicable
    Color of teeth:(_)Yellow(_)Brownish-Yellow(_)Brown(_)Black(_)No teeth(_)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
    (_)can't get there from here
    BUMPER STICKERS:___ Eat more Possum___ My other car is a piece of junk too
    ___ Honk if you love Jesus___ If you ain't a cowboy, you ain't nothin'
    ___ Red-man Chewing Tobacco
    Favorite Recreation: Check all that apply:___ Square Dancin' ___ Possum Huntin'
    ___ Skinny Dippin'___ Craw Daddin'___ Gospel Singin' ___ 4-Wheelin'___ Drankin' ___ Spittin' Backy ___ Bill Chip Trowin' ___ Honky Tonkin'___ Noodlin'
    # of Dogs: ___ Type: ___ Blue Tick ___ Beagle___ Black & Tan ___ Bird Dawg
    Cap Emblem: ___ John Deere ___ McCulloch Chain Saws___ Budweiser
    ___ Vo-Tech___ Skoal ___ Coors___ NAPA ___ Smile if you're Not Wearing Underwear
    Last edited by k12311997; 05-16-2007 at 11:09 AM.

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