Mississippi Driver's License Application
     
Last name: ________________
     
First name: ________________
     
(_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(Check appropriate box)
     
Age: ____ (if unsure, guess)
     
Sex: ____ M _____ F _____ Not sure
     
Shoe Size: ____ Left ____ Right
     
Occupation:
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Un-employed
(_) Dirty Politician
     
Spouse's Name: __________________________
     
2nd Spouse's Name: __________________________
     
3rd Spouse's Name: __________________________
     
Lover's Name: _________________________
     
2nd Lover's Name: _________________________
     
Relationship with spouse:
(_) 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: _______________________ 
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: _____________ 194_
     
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 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 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
(_) don't know