"Application to live in Mississippi" joke

NAME: ___________________________________ C.B. HANDLE: ____________________ ADDRESS: (R.F.D. - H.C.R.) _________________________________________________ DADDY (If unknown, attach list of 3 suspects): _____________________________ MAMA: ______________________________________________________________________ NECK SHADE: ( ) LIGHT RED ( ) MEDIUM RED ( ) DARK RED NUMBER OF TEETH EXPOSED IN FULL GRIN: _______ UPPER: _______ LOWER: _______ MAKE OF PICKUP OWNED: _____________________ SIZE OF TIRES: ________________ NUMBER OF EMPTY BEER CANS ON FLOOR OF PICKUP: ______________________________ TRUCK EQUIPPED WITH: ( ) GUN RACK ( ) MUD FLAPS ( ) CAMPER TOP ( ) AIR HORN ( ) 8 TRACK ( ) 4 WHEEL DRIVE ( ) AMERICAN FLAG ( ) RUST ( ) FUZZ BUSTER ( ) LOAD OF WOOD ( ) HIJACK SHOCKS ( ) MUD TIRES ( ) SPITTOON ( ) RUNNING BOARDS ( ) C.B. ANTENNAS ( ) ROLL BAR BUMPER STICKERS: ( ) HONK IF YOU'RE HORNY ( ) HONK IF YOU LOVE JESUS ( ) ALMOST HEAVEN, BUCKSPORT ( ) SNATCH KISSES AND VICE VERSA ( ) OLD FART ( ) I LOVE HINEY WINE ( ) SHIT HAPPENS ( ) REDMAN CHEWING TOBACCO ( ) WOOD IS WONDERFUL ( ) SAVE THE BLACK FLY ( ) DON'T LIKE MY DRIVING? CALL 1-800-EAT-SHIT ( ) ALL YOU ECOLOGICAL BASTARDS CAN FREEZE IN THE DARK FAVORITE BEVERAGE: ( ) BUSCH ( ) STAG ( ) OLD STYLE ( ) FALSTAFF ( ) BUCKHORN ( ) RED WHITE & BLUE ( ) BUDWEISER ( ) OLD MILWAUKEE FAVORITE VOCALIST: ( ) ELVIS ( ) CONWAY TWITTY ( ) LORETTA LYNN ( ) SLIM WHITMAN ( ) JOHNNY CASH ( ) WILLIE NELSON ( ) DICK CURTIS ( ) GEORGE JONES ( ) YOURSELF IN THE SHOWER FAVORITE RECREATION: ( ) SQUARE DANCING ( ) COON HUNTING ( ) FISHING WITH THE BOYS ( ) DRINKING ( ) BLUE GRASS FEST ( ) FISHING ALONE ( ) RACE TRACK ( ) FLOATING ( ) DEER HUNTING ( ) APPLE BUTTER FEST ( ) THREE WHEELING ( ) RODEO HOW MANY CARS DO YOU HAVE UP ON BLOCKS IN YOUR FRONT YARD? _________________ HOW MANY KITCHEN APPLIANCES ARE ON YOUR FRONT PORCH? ____ HOW MANY WORK? __ NUMBER OF HOUNDS: _________ TYPE: ( ) BLUE TICK ( ) BEAGLE ( ) BLACK/TAN MEMBERSHIPS: ( ) NRA ( ) VFW ( ) PTL CLUB ( ) DUCKS UNLIMITED ( ) FISH & GAME CLUB ( ) KKK ( ) WACKY WARRIORS ( ) ELKS BASEBALL CAP EMBLEM: ( ) JOHN DEERE ( ) FORD ( ) SKOAL ( ) CAT ( ) BUDWEISER ( ) CHEVY ( ) BASS PRO ( ) EAT ME ARE YOU MARRIED TO ANY OF THE FOLLOWING? (Check all that apply) ( ) SISTER ( ) COUSIN ( ) COUSIN'S SISTER ( ) SOW DOES YOUR WIFE WEIGHT MORE THAN YOUR PICKUP? ( ) YES ( ) NO DO YOU WEAR MOSTLY POLYESTER PANTS WITH SNAGS? ( ) YES ( ) NO DO YOU OWN ANY SHOES (NOT COUNTING BOOTS)? IF SO, HOW MANY? ______________ LENGTH OF RIGHT LEG: _________________ LENGTH OF LEFT LEG: _________________ CAN YOU SIGN YOUR NAME AND SPELL IT CORRECTLY EVERY TIME? ( ) YES ( ) NO HAVE YOU EVER HAD MORE THAN ONE BATH A WEEK? ( ) YES ( ) NO ARE YOU A REGISTERED VOTER? ________ DO YOU KNOW WHERE TO DO IT? ________ DO YOU WONDER IF YOU NEED TO FILE A TAX RETURN? ( ) YES ( ) NO DO YOU WORRY THAT YOUR HOUSE COULD BLOW AWAY IN HIGH WINDS? ( ) YES ( ) NO WHEN WAS YOUR LAST UFO SIGHTING? ___________ ELVIS SIGHTING? ___________ MEDICAL INFORMATION (DO YOU HAVE AT LEAST TWO OF THE FOLLOWING?): ( ) B.O. ( ) CRABS ( ) HEAD LICE ( ) BAD BREATH ( ) SCABIES ( ) YELLOW TEETH ( ) GREEN TEETH ( ) FLEAS ( ) RUNNY NOSE ( ) TATTOOS ( ) CROSSED EYES ( ) STUTTER SIGNATURE (ONE `X' WILL DO) ___________________________ DATED: ____________

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