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October 2017

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Application to Live in Mississippi

Application to Live in Mississippi

Name: ________________
(_) 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
Occupation:
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Un-employed

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

Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed

Model and year of your pickup: _____________ 194_

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

Newspapers/magazines you subscribe to:
(_) The National Enquirer (_)The Globe
(_) 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

How often do you bathe:
(_)Weekly
(_)Monthly
(_)Not Applicable

Color of teeth:
(_)Yellow (_)Brownish-Yellow
(_)Brown (_)Black (_)N/A

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

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

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