2010 Redneck Census Form

The official year 2010 Redneck Census 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 appropriate box)
(_)Sister
(_)Brother
(_)Aunt
(_)Uncle
(_)Cousin
(_)Mother
(_)Father
(_)Son
(_)Daughter
(_)Pet

Number of children living in the home:_____

Number of the children living in the 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 commpleted)

(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 the 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 in the last 5 years 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:
(_)White
(_)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?