APPLICATION FOR ARKANSAS DRIVERS LICENSE

Last name: __________________________

First name: (Check appropriate box)

[_] Billy-Bob [_] Bobby-Sue

[_] Billy-Joe [_] Bobby-Jo

[_] Billy-Ray [_] Bobby-Ann

[_] Billy-Sue [_] Bobby-Lee

[_] Billy-Mae [_] Bobby-Ellen

[_] Billy-Jack [_] Bobby-Beth

Age: ____ (if unsure, guess)

Sex: ____ M _____ F _____ Not sure

Shoe Size: ____ Left ____ Right

Occupation:

[_] Farmer [_] Mechanic

[_] Hair Dresser [_] Waitress

[_] Unemployed [_] Dirty Politician

Spouse's Name: __________________________

2nd Spouse's Name: _______________________

3rd Spouse's Name: _______________________

Lover's Name: ____________________________

2nd Lover's Name: ________________________

Relationship to spouse:

[_] Sister [_] Aunt

[_] Brother [_] Uncle

[_] Mother [_] Son

[_] Father [_] Daughter

[_] Cousin [_] Pet

Number of children living in household: ___

Number of children living in shed: ___

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
Where you keep them firearms:
____ truck ____ kitchen

____ bedroom ____ bathroom
____ shed

Model and year of your pickup:
____________ 194_
Do you have a gun rack?

[_] Yes [_] No; If no, please
explain:______________________________.

Newspapers/magazines you read:

[_] 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 [_] 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