THE FEDERAL CENSUS FOR THE SOUTH 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 ______ Color of eyes: Left______ Right_____ Color of hair: (_) Blond (_) Black (_) Red (_) Brown (_) White (_) Clairol Color of teeth: (_) Yellow (_) Brownish-Yellow (_) Brown (_) Black (_) N/A How often do you bathe: (_) Weekly (_) Monthly (_) Not Applicable Brand of chewing tobacco you prefer: (_) Red-Man Education: 1 2 3 4 (Circle highest grade completed) 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) Occupation: (Check appropriate box) (_) Farmer (_) Mechanic (_) Hair Dresser (_) Unemployed Do you (_) own or (_) rent your mobile home? How far is your home from a paved road? (_) 1 mile (_) 2 miles (_) just a whoop-and-a-holler (_) road? 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: ___ Model and year of your pickup: 196__ Do you have a gun rack? (_) Yes (_) No; If no, please explain:____________________ Firearms you own and where you keep them: ____ truck ____ bedroom ____ bathroom ____ kitchen ____ shed 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:_____ End