Education: 1 2 3 4 (Circle highest grade completed)
If you obtained a higher education what was your
major?
[_] 5th grade [_] 6th grade
Do you [_] own or [_] rent your mobile home?
Vehicles you own and where you keep them:
___ 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
Age you started drivin ______
(If over 10 are you still slow lernin? [_] Yes [_]
No)
Firearms you own and where you keep them:
___ truck ____ kitchen
___ bedroom ____ bathroom/outhouse
___ shed ____ pawnshop
Model and year of your pickup: _____________ 194_
Do you have a gun rack?
[_] Yes [_] No; If no, please explain:
Newspapers/magazines you subscribe to:
[_] The National Enquirer [_] The Globe
[_] TV Guide [_] Soap Opera Digest
[_] Rifle and Shotgun [_] Bassmasters
___ 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
How many teeth in YOUR mouth? ___ Color of teeth:
[_] Yellow [_] Brownish-Yellow
[_] Brown [_] Black
[_] N/A
How far is your home from a paved road?
[_] 1 mile
[_] 2 miles
[_] don't know
Signature: (if you kan't spell yur name, draw a
pikshur of yurself)
