Census (Southern States)

[Rolex]

Census For The South


Last name if known: ________________
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 _____ No preference_____
Shoe Size: ____ Left ____ Right

Occupation: (Check appropriate box)
(_) Mechanic
(_) Hair Dresser
(_) Unemployed

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
(_) Pet
(_) Farm Animal - Please specify:_____________

Number of children living in household: _____
Number of children living in shed: ______
Number that are yours: ______
Number of children that sleep in the tub:______

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 trailer? (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: ___ (Minimum of one required by zoning ordinance)

Firearms you own and where you keep them: (Check all that apply)
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed


Model and year of your pickup: 196_
Do you have a gun rack?
(_) Yes (_) No; If NO, please explain:__________________
_______________________________________________

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
(_) 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
(_) Paved?

Type of beverage preferred:
(_) Beer
(_) Moonshine


Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
(_) Rifle and Shotgun
(_) Road Kill Grillin'

Do you have indoor plumbing?
(_) No

How many hound dogs live on or under your porch?_____


Your response is required by law, whether or not your holler has any.

 

[hamz9561]

They forgot:

How many times have you been on the local news describing how the tornado looked coming through your trailer park. __

How many times have been arrested (Once required by law)? __

Have you ever been accused of lying through your tooth by the Justice of the Peace?
__ Yes __ No If NO explain: ____________________________________