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
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