straight from wv.gov

West Virginia State Residency Application

Name: ________________
(last)
(first) (_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right

CB Handle: _____________________

Occupation:
(_)Farmer
(_)Mechanic
(_)Hair Dresser
(_)Un-employed
(_)Coal Miner

Spouse's Name: __________________________

Relationship with spouse:
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet

Number of children living in household: ___

Number that are yours: ___

Mother's Name: _______________________

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

___ Number of refrigerators on front porch

Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed

Model and year of your pickup: _____________ 194__
Number of empty beer cans on floorboard or in bed of
pickup: _________

Newspapers/magazines you subscribe to:
(_)The National Enquirer
(_)The Globe
(_)TV Guide
(_)Soap Opera Digest
(_)Gun World

___ 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
(_)Holidays
(_)Not Applicable

Color of teeth:
(_)Yellow
(_)Brownish-Yellow
(_)Brown
(_)Black
(_)No teeth
(_)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
(_)can't get there from here

BUMPER STICKERS:
___ Eat more Possum
___ My other car is a piece of junk too
___ Honk if you love Jesus
___ If you ain't a cowboy, you ain't nothin'
___ Red-man Chewing Tobacco

Favorite Recreation: Check all that apply:
___ Square Dancin'
___ Possum Huntin'
___ Skinny Dippin'
___ Craw Daddin'
___ Gospel Singin'
___ 4-Wheelin'
___ Drankin'
___ Spittin' Backy ___ Bill Chip Trowin'
___ Honky Tonkin'
___ Noodlin'

# of Dogs: ___ Type: ___ Blue Tick ___ Beagle
___ Black & Tan ___ Bird Dawg

Cap Emblem: ___ John Deere ___ McCulloch Chain Saws
___ Budweiser ___ Vo-Tech
___ Skoal ___ Coors
___ NAPA ___ Smile if you're Not Wearing Underwear