Name:_____________________________________________________________
Nickname:___________________________ CB Handle:____________________ Address
(RFD):______________________________________________________ Daddy (if unknown afix list
of 3 suspects):_________________________

Neck size:____ [] Light Red [] Medium Red [] Dark Red []

Other Number of teeth exposed in full grin:_______ Upper:_____ Lower:____

Make of Pickup:_________________________ Tire Size:_________________

Hounds:_____________ Type: [] Blue Tick [] Beagle [] Black and Tan
Length of right leg:__________ Length of left leg:__________ other:_________

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

Are you married to any of the following? (circle all that apply) -Sister -Cousin -Cousin's Sister -Other, Explain:____________________________________________________

Have you EVER had more than one bath a week? [] No [] Yes, Explain:___________________________________________

*Medical Information*
Do you have at least two (2) of the following: [] B.O. [] Lice [] Crabs [] Bad Breath [] Hoof in Mouth [] Scabs [] Fleas [] Infected Tatoos [] Crossed eyes [] Runny Nose [] Green Teeth [] Yellow Teeth [] Any Teeth [] Speach Impediment

*General Information* Can you count past 20 without stripping? [] yes [] no [] never tried

Favorite Weapon: [] Tire Iron [] Pick Handle [] Log Chain [] Shotgun

Favorite Pastime: [] Drinkin' [] Coon Huntin' [] Fishin' [] Fuedin'[]

Other Truck equipped with: [] Gun Rack [] Fuzzbuster [] 8-Track [] Rebel Flag [] Roll Bar [] C.B. Radio [] Beer Cans [] Squirrel Tail [] Bull Horns

Favorite Vocalist: [] Elvis (the young Elvis) [] Elvis (the old Elvis) [] Elvis (dead)

Cap Emblems: [] John Deere [] CAT [] SKOAL [] Budweiser [] Bud Dry [] Jack Daniels [] Teamsters local

Merberships: [] NRA [] VFW [] KKK [] 700 Club [] B.P.O.E. [] Sine-aid Society

Do you vote? [] Yes [] No []

What's that? Have you ever been in jail? [] Yes [] No [] Born there