West Virginia State Residency Application

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  1. Last Name: _________________________

  2. First Name:
    ____ Billy-Bob
    ____ Billy-Joe
    ____ Billy-Ray
    ____ Billy-Sue
    ____ Billy-Mae
    ____ Billy-Jack
    (Check appropriate box)

  3. Age: ____
  4. Sex: ____ M ____ F _____ N/A
  5. Shoe Size: ____ Left ____ Right
  6. CB Handle: _____________________

  7. Occupation:
    ____ Farmer
    ____ Mechanic
    ____ Hair Dresser
    ____ Un-employed
    ____ Coal Miner

  8. Spouse’s Name: __________________________

  9. Relationship with spouse:
    ____ Sister
    ____ Brother
    ____ Aunt
    ____ Uncle
    ____ Cousin
    ____ Mother
    ____ Father
    ____ Son
    ____ Daughter
    ____ Pet

  10. Number of children living in household: ___
  11. Number that are yours: ___
  12. Mother’s Name: _______________________
  13. Father’s Name: _______________________ (If not sure, leave blank)
  14. Education: 1 2 3 4 (Circle highest grade completed)
  15. Do you (__)own or (___)rent your mobile home? (Check appropriate box)

  16. Vehicles:
    ____ 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

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

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

  19. Newspapers/magazines you subscribe to:
    ____ The National Enquirer
    ____ The Globe
    ____ TV Guide
    ____ Soap Opera Digest
    ____ Gun World

  20. ____ Number of times you’ve seen a UFO
  21. ____ Number of times you’ve seen Elvis
  22. ____ Number of times you’ve seen Elvis in a UFO

  23. How often do you bathe:
    ____ Weekly
    ____ Monthly
    ____ Holidays
    ____ Not Applicable

  24. Color of teeth:
    ____ Yellow
    ____ Brownish-Yellow
    ____ Brown
    ____ Black
    ____ No teeth
    ____ N/A

  25. Brand of chewing tobacco you prefer:
    ____ Red-Man

  26. How far is your home from a paved road?
    ____ 1 mile
    ____ 2 miles
    ____ don’t know
    ____ can’t get there from here

  27. Reason for continued residence in West Virginia:
    ____ can’t bear to leave brother’s behind
    ____ daddy won’t give me my pants back
    ____ liberal wife beating laws

  28. Bumper Stickers:
    ____ Eat more Possum
    ____ My other car is a piece of shit too
    ____ Honk if you love Jesus
    ____ If you ain’t a cowboy, you ain’t shit
    ____ Red-man Chewing Tobacco
    ____ Wave if you’re horny

  29. Favorite Recreation:
    ____ Square Dancin’
    ____ Possum Huntin’
    ____ Skinny Dippin’
    ____ Craw Daddin’
    ____ Gospel Singin’
    ____ 4-Wheelin’
    ____ Drankin’
    ____ Spittin’ Backy
    ____ Bull Chip Trowin’
    ____ Honky Tonkin’
    ____ Noodlin’
    ____ Other

  30. Number of Dogs: ____
    • Type:
      ____ Blue Tick
      ____ Beagle
      ____ Black & Tan
      ____ Bird Dawg

  31. Cap Emblem:
    ____ John Deere
    ____ McCulloch Chain Saws
    ____ Budweiser
    ____ Vo-Tech
    ____ Skoal
    ____ Coors
    ____ NAPA
    ____ Smile if you’re Not Wearing Underwear

  32. Memberships:
    ____ KKK
    ____ NRA
    ____ Moose
    ____ PTL Club
    ____ AA
    ____ Bass Club
    ____ VFW
    ____ Quiltin’ Bee
    ____ American Legion
    ____ United Sons/Daughters of the Confederacy
    ____ John Birch Society

  33. Do you have at least two of the following medical conditions:
    ____ B.O.
    ____ Crabs
    ____ Head Lice
    ____ Rabies
    ____ Trench Mouth
    ____ Runny Nose
    ____ Bad Breath
    ____ Chafing