(Completed application must be filed with John Scott Muir, Dept. of Weights and Measures)
Name
Nickname CB Handle
Address(RFD)
Daddy (If unknown, list 3 suspects)
Neck Shade ( ) 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 ( ) Other
Length of Right Leg Length of Left Leg
How Many Cars/ Makes in Front Yard On Blocks
How many Kitchen Appliances In Front Porch Back Porch
When & Where was your last Elvis sighting?
Are you married to any of the following?
( ) Sister ( ) Cousin ( ) Cousin's Sister ( ) Aunt ( ) Other-Explain
Do you wear mostly polyester pants with snags? ( ) Yes ( ) No
Do you own any other shoes other than boots? ( ) Yes ( ) No
Does your wife weigh more than your truck? ( ) 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
MEDICAL INFORMATION
Do you have at least two of the following?: ( ) BO ( ) Crabs ( ) Lice ( ) Bad Breath
( ) Scabs ( ) Fleas ( ) Tattoos ( ) Crossed Eyes ( ) Runny Nose
( ) Green Teeth ( ) Yellow Teeth ( ) Brown Teeth ( ) Any Teeth-Explain
GENERAL INFORMATION
Can you count past ten (10) with your shoes on? ( ) Yes ( ) No
Can you count past 21 with your fly up? ( ) Yes ( ) No
Favorite Weapon: ( ) Tire Iron ( ) Log Chain ( ) Shot Gun ( ) Pick
Favorite Past Time: ( ) Drinkin ( ) Coon Huntin ( ) Fishin ( ) Other-Explain
Trucks Equiped with: ( ) Gun Rack ( ) Fuzz Buster ( ) 8-Track ( ) CB ( ) Rebel Flag
( ) Roll Bar ( ) Beer Cans ( ) Squirrel Tail
Your Signature (an X will do)
