Do you [_] own, or [_] rent your mobile home? (Check appropriate box)
Vehicles you own and where you keep them: ___ 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 ____ kitchen ____ bedroom ____ bathroom ____ shed
Model and year of your pickup: _____________ 194_
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
How many teeth? ___ 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
