State of Arkansas Residency Application

State of Arkansas

Residency Application

Name: ________________ (_) Billy-Bob (last) (_) 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

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



State of Arkansas Residency Application