The 2010 Federal Census For The State of ARKANSAS 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 Spouses Name:_________________________ 2nd Spouses Name:______________________ 3rd Spouses Name:______________________ Lovers 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: ______ Mothers Name: _______________________(If not sure, leave blank) Fathers Name: _______________________ (If not sure, leave blank) Ed ucation: 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 (_) None(_) 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 (_) What's a road?