2010 Census Form for Rednecks
>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:______________________
>
>Relationship with spouse: (Check appropriate box)
>(_) Sister
>(_) Brother
>(_) Aunt
>(_) Uncle
>(_) Cousin
>(_) Mother
>(_) Father
>(_) Son
>(_) Daughter
>(_) Pet
>
>Number of children living in household: _____
>Number of children living in 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 completed)
>
>Do you (_) own or (_) rent your mobile home? (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 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:
>(_) 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?