Bill Clinton Governor APPLICATION TO LIVE IN ARKANSAS Name ___________________________________________________________________________ Nickname ___________________________________CB Handle __________________________ Daddy (if unknown attach list of 2 suspects) ___________________________________ NECK SHADE ( ) Light Red ( ) Medium Red ( ) Dark Red ( ) Other _______ Number of teeth exposed in full grin ____________Upper _________Lower __________ Make of Pickup ___________________________________Size of tire _________________ HOUNDS __________ TYPE ( ) Blue Tick ( ) Beagle ( ) Black & Tan ( ) Other Length of Right Leg ________________________Length of Left Leg _________________ How Many cars makes in front yard ________________How many on blocks ___________ How Many kitchen appliances on front porch _______________Back porch ___________ When and where was your last ELVIS Sighting __________________________________ Do you wear mostly polyester pants with snags ( ) YES ( ) NO Do you own any shoes(Not boots) ( ) YES ( ) NO Are you married to any of the following(Circle all that apply) Sister Cousin Cousin s Sister Aunt Other Explain ________________________________________ Does your wife weigh more than your pickup ( ) YES ( ) NO Can you sign your own name and always spell it right ( ) YES ( ) NO Have you EVER had more than one bath in a week ( ) YES ( ) NO Explain _____ MEDICAL INFORMATION Do you have atleast two(2) of the following ( ) B O ( ) Crabs ( ) Lice ( ) Bad Breath ( ) Scabies ( ) Fleas ( ) Tatoos ( ) Crossed Eyes ( ) Runny Nose ( ) Green Teeth ( ) Brown Teeth ( ) Yellow Teeth ( ) Any Teeth ( ) Number of Teeth Missing __________________________________________________________________ GENERAL INFORMATION Can you count past ten with your shoes on ( ) YES ( ) NO Past 21 with your fly up ( ) YES ( ) NO Favorite Weapon ( ) Tire Iron ( ) Pick Handle ( ) Log Chain ( ) Shotgun Favorite Pastime ( ) Drinkin ( ) Coon Huntin ( ) Fishin ( ) Other __________ Truck Equipped with ( ) Gun Rack ( ) Fuzzbuster ( ) 8 Track ( ) Rebel Flag ( ) Roll Bar ( ) C B Radio ( ) Beer Cans ( ) Squirrel Tail Favorite Vocalist ( ) Willie Nelson ( ) Johny Cash ( ) Elvis ( ) Conway Twitty ( ) Loretta Lynn Bumper Stickers ( ) Honk if you LOVE Jesus ( ) Dial 1-800-Eat Shit ( ) Old Fart ( ) Dig Clams Cap Emblems ( ) John Deere ( ) CAT ( ) SKOAL ( ) Budweiser ( ) Jack Daniels Memberships ( ) NRA ( ) VFW ( ) KKK ( ) 700 Club ( ) B P O E Your Signature (one X will Due) __________________________Date ________________