STATE OF KENTUCKY RESIDENCY APPLICATION



Name: ________________                    Billy-Bob (Check appropriate box for first name)
          (last)                               Billy-Joe
                                                  Billy-Ray
                                                  Billy-Sue
                                                  Billy-Mae
                                                  Billy-Jack

Age: ____ Sex: ____ M _____ F _____ N/A Shoe Size ____ Left ____ Right

Occupation:                    Farmer                                        Mechanic
                              Hair Dresser                              Unemployed

Spouse's Name: __________________________

Relationship with spouse:
                    Sister                              Brother                    Aunt
                    Uncle                              Cousin                              Mother
                    Father                              Son                              Daughter                    Pet

Number of children living in household: ___ 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; 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