First name: ______________________
Last name(if known):______________
Address (where you live):_________
- ________________________________
Mother's name_____________________
(also relation, i. E., sister)
Birthdate(yours):__________________
Father's name:_____________________
(if known, if not, list choices)
Color of neck:
Light Red ( )
Medium Red( )
Dark Red ( )
No Neck ( )
Year of pickup truck:_____________
List all that you have in your truck:
Fuzzy Dice( ) Gun Rack( ) Сооn Tail( )
Filled ash tray( ) Dead Road Кill( )
Dog of Unknown Breed( )
Have you ever been to a large city?
(Like Little Rock) Yes ( ) No ( )
How far can you throw соw pies?____
Do you eat соw pies? Yes( ) No( )
Wife's name:__________________
Is she: Cousin( ) Neighbor( )
Sister( ) Aunt ( ) Mother( )
Neighbor's dog( )
Does your wife weigh:
Less than 200 Pounds( )
Less than 300 Pounds( )
Less than a 747( )
More than a 747( )
Do you know what a 747 is?
Yes( ) No( )
How much smarter than you
Is your wife:
50 IQ Points( ) 75 IQ Points( )
100 IQ Points( ) She Won't Tell Me( )
Does your wife wear:
A Dress( ) Pants( ) Hot Pants( )
Your Pants( ) Them Lawyer Clothes( )
Nothing( )
Understood previous questions:
Yes( ) No( ) Huh?( )
All of the Above( )
What "previous" mean?( )
Color of wife's hair:
Blonde( ) Red( ) Brown( )
Black( ) Bald( )
Last Elvis sighting:
Location: ________________
On what date?_____________
Can you count past five:
Yes( ) No( ) Past ten: Yes( ) No( )
Explain in ten words or less
Why on Earth you want to be Governor
Of Arkansas:
- ______________________________
Signature ('X' if you can't write)
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