Voodoo Animal

NAME:_________________________________
Nickname:_________________________________

CB Handle:____________________________ Address
(RFD)______________________________


__________________________________________________ ________________________________

Daddy (Unknown, attach list of 3
suspects):________________________________________ ____

NECK SHADE: ( ) LIght Red ( ) Medium Red ( ) Dark Red ( )
Other:________________

Number of teeth exposed in full grin: _____ Upper:_____ lower:_____

Make of Pickup:____________________ Size of tire:____________

HOUNDS:________ Type: ( ) Blue Tick ( ) Beagle ( ) Black & Tan ( )
Other:____________

Lenth of right leg:___________ Length of left leg:_____________

How many cars/makes in front yard?___________ How many on
blocks?_________________

How many k itchen appliances on front porch?_________ Back
porch?___________________

When and whnere was your last "Elvis
sighting?______________________________________

Do you mostly wear polyester pants with snags? ( ) YES ( ) NO

Do you own shoes (not boots)? ( ) YES ( ) NO

Does your wife weigh more than your pickup? ( ) YES ( ) NO

Have you ever had more than one bath in a week? ( ) YES ( ) NO


Explain:__________________________________________ ________________________________



MEDICAL INFORMATION:

Do you have at least two (2) of the following?: ( ) B.O. ( ) Crabs ( )
Lice ( ) Bad Breath

( ) Scabies ( ) Fleas ( ) Tatoos ( ) Crossed Eyes ( ) Runny NOse ( )
Green Teeth

( ) Brown Teeth ( ) Yellow Teeth ( ) Any Teeth ( ) Number of Teeth
missing?__________

GENERAL INFORMATION:

Can you count past 10 with your shoes on? ( ) YES ( ) NO
Past 21 with your Fly up? ( ) YES ( ) NO

Favorite Weapon: ( ) Tire Iron ( ) Pick Handle ( ) Log Chain ( ) Shotgun

Favorite Pastime: ( ) Drinkin ( ) Coon Huntin ( ) Fishin ( ) Other


Explain:__________________________________________ ________________________________

Truck Equiped with: ( ) Gun Rack ( ) Fuzzbuster ( ) 8 Track ( ) Rebel
Flag

( ) Roll Bar ( ) CB Radio ( ) Beer Cans ( ) Squirel Tail

Favorite Vocalist: ( ) Willie Nelson ( ) Johny Cash ( ) Elvis ( ) Conway
Twitty

( ) Loretta Lynn

Bumper Stickers: ( ) Honk if you Love Jesus ( ) Dial 1-800-EAST-**** ( )
Old Fart

( ) I Dig Clams

Cap Emplems: ( ) John Deere ( ) CAT ( ) SKOAL ( ) Budweiser ( ) Jack
Daniels

Membership: ( ) NRA ( ) VFW ( )KKK ( ) 700 C LUB ( ) B.P.O.E.

ARREST:

Have you ever been or are you fixin to be arrested on Probation, Parrole
( ) YES ( ) NO

LAW SUETS:

Are you currently involved in a lawsuet or waiting for a settlement from
a Law Suet?

( ) YES ( ) NO If you said yes please
explain:_____________________________________


__________________________________________________ ______________________________

DRUNKENESS:

Do you drive a vechile while under the influence of Alcohol? ( ) YES ( )
NO

What is your favorite drinking stop? ( ) Pillars ( ) Georges Lounge

( ) American Legion ( ) VFW

Do you have fitts of public drunkeness? ( ) YES ( ) NO

MARRAGE:

Were you wedded at the Lions Club ? ( ) YES ( ) NO

Are you married to any of the following? (Check all that apply): ( )
Sister ( ) Cousin

( ) Cousin's Sister ( ) Aunt ( ) Other,


Explain:__________________________________________ _______________________________


__________________________________________________ ______________________________

Did you meet your wife at a back yard family BAR-B-Q? ( ) YES ( ) NO

AFFILIATIONS:

Does or is your last name end in Crowe? ( ) YES ( ) NO

Your Signature (If unable to Sign your Name a X will
do)__________________Date:________

DLISH