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PG:26
The 2000 Federal Census for Texas, Arkansas, Alabama and West Virginia

Last name: ________________

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 _____ Not sure

Shoe Size: ____ Left ____ Right

Occupation: (Check appropriate box)(_) Farmer(_) Mechanic(_) Hair Dresser(_) Unemployed(_) Dirty Politician(_) Preacher

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(_) Mother(_) Father(_) Son(_) Daughter(_) Pet

Number of children living in household: _____

Number of children living in shed: ______

Number that are yours: ______

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 mobile home? (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: ___

Firearms you own and where you keep them:____ truck____ bedroom____ bathroom____ kitchen____ shed

Model and year of your pickup: 196_

Do you have a gun rack?(_) Yes (_) No; If no, please explain:

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

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(_) Black(_) 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(_) road?

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