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 OtherLength 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 shoesNot boots? YES NO
Are you married to any of the followingCircle all that apply: Sister Cousin
Cousins 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 two2 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: