From: Michael S. Lorrey (retroman@turbont.net)
Date: Thu Apr 20 2000 - 05:51:53 MDT
Uyuh, this is a good'un:
Census 2000, The Southern Long Form
>
> 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 all appropriate boxes)
> (_) 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 run: ___
>
> 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 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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