Application to Live in Indiana

Name:_______________________________________________________________________
Nickname:_____________________________________ CB handle:___________________
Address (RFD):______________________________________________________________

Daddy (If unknown, attach list of suspects):________________________________
Neck size:__________ ( )Light red  ( )Medium red  ( )Dark red  ( )Other
Number of teeth exposed in full grin:   ________upper   _________lower

Make of pickup:________________________ Size of Tires:______________________
Hounds:__________   Type: ( )Blue Tick  ( )Beagle  ( )Black & Tan  ( )Mutt
Length of hound`s left leg:____________ Length of right 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?________________________________
When and where was your last UFO sighting?__________________________________

Do you wear mostly polyester pants with snags?   ( )Yes    ( )No
Do you own any shoes (not boots or sneakers)?    ( )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

Does your wife weigh more than your pickup?      ( )Yes    ( )No
Is your wife one of the following?  ( )Sister  ( )Cousin  ( )Aunt  (
)Daughter

MEDICAL INFORMATION:

Do you have at least two (2) of the following:  ( )B.O.   ( )Lice   ( )Fleas
( )Tattoos   ( )Runny nose   ( )Green teeth   ( )Brown teeth   ( )No teeth

GENERAL INFORMATION:

Can you count past 10 with your shoes on?        ( )Yes   ( )No
Past 21 with your fly up?                        ( )Yes   ( )No

Favorite weapon:   ( )Tire iron   ( )Pick handle   ( )Log chain   ( )Shotgun
                   ( )Metal bat   ( )Wife`s purse  ( )Teeth

Favorite pastime:  ( )Drinkin`    ( )Coon huntin`  ( )Fishin`     (
)Scratchin`
                   ( )Four-wheelin`  ( )Sleepin`   ( )Complainin`

Truck equipped with (check all that apply):  ( )Gun rack   ( )Fuzzbuster
                   ( )8-track     ( )Rebel flag    ( )Roll bar    ( )C.B.
radio
                   ( )Beer cans   ( )Squirrel tail ( )Fishin` rod ( )Couch
                   ( )Two tone cap( )Rust          ( )Seat cover  ( )Plywood

Favorite vocalist: ( )Willie Nelson  ( )Johnny Cash  ( )Elvis  ( )Conway
Twitty
                   ( )Randy Travis   ( )Garth Brooks ( )Billy Ray Cyrus

Cap emblems:       ( )John Deere     ( )Ford       ( )CAT      ( )SKOAL
                   ( )Budweiser      ( )Jack Daniels     ( )Penzoil

Memberships:       ( )NRA   ( )VFW   ( )KKK    ( )700 Club     ( )B.P.O.E.
                   ( )PTA   ( )Boy Scouts   ( )Voluteer Fire Department
                   ( )American Legion       ( )Knights of Columbus

Your signature (one X will do):________________________________
Date___________