Name:__________________________  Nickname:____________________
Address:_____________________________  RFD#:__________
CB Handle:____________

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PERSONAL INFORMATION:
 

Daddy: (if unknown, attach list of suspects):______________________________
Mama:________________________________

Education (circle highest grade completed):  K  1  2  3  4  5  6  7  8
Have you obtained higher education?  ___Yes    ___No
  -If yes to the above, what year did you get your G.E.D.?  ________

Do you own (or plan to own) shoes?:  ___Yes   ___No

Shade of Neck:    ___Light Red   ___Medium Red   ___Dark Red

Length of Legs:   Left:_______   Right:______

Are you married to any of the following:
___Sister/Brother  ___Cousin   ___Niece/Nephew   ___Aunt/Uncle

Club/Organization Memberships:
___NRA   ___VFW   ___Masons   ___Sons/Daughters of the Confederacy
___KKK   ___PTL   ___American Legion

Preferred foods:
___Grits       ___Chitlins       ___Cobbler        ___Taters
___Goobers     ___Red Eye Gravy  ___Fatback        ___Pig Skins
___Collards    ___Sawmill gravy  ___Biscuits       ___Cornbread
___Side Meat   ___Molasses       ___Poke           ___'shine
___Pinto beans ___Turnip Greens  ___RC & Moon Pies ___Potted meat and Crackers

Favorite Vocalists/Groups:
___Porter Waggoner   ___Conway Twitty   ___Boxcar Willie    ___Charlie Daniels
___Tammy Wynette     ___Loretta Lynn    ___Johnny Cash      ___Barbara Mandrell
___Willie Nelson     ___Hank Willams    ___Dwight Yoakum    ___The Judds
___Alabama           ___George Jones    ___Bellamy Brothers ___Randy Travis

Favorite Recreation:
___Drankin'         ___Spittin' backy       ___Front Porch Rockin'
___Square Dancin'   ___Skinny Dippin'       ___Liar's Bench
___Possum Huntin'   ___Bull Chip Throwin'   ___Cloggin'
___Fishin'          ___Spotlighting (deer)  ___Cockfights

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FAMILY INFORMATION:

How many children do you have (circle appropriate number):
         5  6  7  8  9  10  11  12  More

How many children do you suspect you have, not listed above:____________

Total number of dependents:   Legal________   Claimed________

Is your spouse heavier than your pick up truck: ___Yes  ___No

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OCCUPATIONAL INFORMATION:

How do you plan to earn your income while living in Kentucky:
___Coal Mine   ___Raise Horses/Cattle   ___Recieve Welfare   ___Raise  tobacco
___Farm        ___Steal Horses/Cattle   ___Moonshine         ___Raise Marijuana

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