The 2000 Federal Census for Texas

  Last name: ________________
  First name: (Check appropriate box)
  (_) Billy-Bob
  (_) Billy-Joe
  (_) Billy-Ray
  (_) Billy-Sue
  (_) Billy-Mae
  (_) Billy-Jack
  What does everyone call you?
  (_) Booger
  (_) Bubba
  (_) Junior
  (_) Sissy
  (_) Other___________________
  Age: ____ (if unsure, guess)

  Sex: ____ M _____ F _____ Not sure
  Shoe Size: ____ Left ____ Right

  Occupation: (Check appropriate box)
  (_) Farmer
  (_) Mechanic
  (_) Hair Dresser
  (_) Unemployed
  (_) Dirty Politician
  (_) Preacher

  Spouse's Name:_________________________
  2nd Spouse's Name:______________________
  3rd Spouse's Name:______________________
  Lover's Name:___________________________

  Relationship with spouse: (Check appropriate box)
  (_) Sister
  (_) Brother
  (_) Aunt
  (_) Uncle
  (_) Cousin
  (_) Mother
  (_) Father
  (_) Son
  (_) Daughter
  (_) Pet
  Number of children living in household:_____
  Number of children living in shed: ______
  Number that are yours: ______

  Mother's Name: _______________________(If not sure,
  leave blank)

  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 that 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: 196_
  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

  Number of times you've seen a UFO:_____
  Number of times in the last 5 years 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 eyes:
  Left______ Right_____

  Color of hair:
  (_) Blond
  (_) Black
  (_) Red
  (_) Brown
  (_) White
  (_) Clairol
  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
  (_) just a whoop-and-a-holler
  (_) road?