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Application to live in West Virginia
Application To Live In West Virginia
Name:
Nickname:
CB Handle:
Address: (RFD NO)
Pappy: (If Unknown, Attach List of 3 Suspects)
Mammy:
Neck Shade: ( )Light Red ( )Med. Red ( )Dark Red
Number of Teeth Exposed in Full Grin: Upper: Lower:
Name of Pickup Owned: Height of Truck:
Truck Equipped With:
( )Gun Rack ( )Mud Flaps ( )Camper Top ( )Air Horns
( )8-Track ( )4-Wheel Drive( )Confederate Flag ( )Toothpick Holder
( )Fuzz Buster ( )Load of Wood ( )Hijacker Shocks ( )Mud-Grip Tires
( )Spitoon ( )Mag Wheels ( )Dual CB Antenna ( )Coon Tail
Number of Empty Beer Cans on Floor Boards of Pickup:
Bumper Stickers:
( )Eat More Possum ( )Peanut Butter ( )Honk If You Love Jesus
( )Wave If You're Horny ( )Red Man Chewing Tobacco
Define The Following (Must Be 90% Correct):
1. Grits 6. Muscadine 11. Fatback 16. Pig Skins
2. Goobers 7. Redeye Gravy 12. Tater 17. Pinto Beans
3. Collards 8. Tote 13. Turnip Salit 18. Cobbler
4. Sidemeat 9. Poke 14. Ramps 19. Brogans
5. Chitlins 10. Cracker 15.Shit-on-a-Shingle
Favorite Singer:
( )Elvis ( )Porter Wagoner( )Loretta Lynn ( )Slim Whitman
( )Donna Fargo ( )Conway Twitty ( )Hank Williams ( )Box Car Willie
( )Johnny Cash ( )Willie Nelson ( )Tammy Wynette ( )George Jones
Favorite Recreation:
( )Square Dancin' ( )Possum Huntin' ( )Skinny Dippin'
( )Drankin' ( )Bull Chip Tossin' ( )Spittin' Backy
( )4 Wheelin' ( )Craw Daddin' ( )Other
Weapons Owned:
( )Deer Rifle ( )Bird Gun ( )Varmint Rifle ( )Log Chain
( )Tire Iron ( )Pick Handle ( )Chain Saw ( )Sawed-off Shotgun
Number of Hound Dogs:
Type: ( )Blue Tick ( )Black & Tan ( )Beagle
Cap Emblem:
( )John Deere ( )Cat ( )Bud ( )Coors
( )McCullock Chain Saws ( )Napa ( )Skoal ( )PBR
Number of Weeks Unemployed:
Number of Welfare Checks Received:
Number of Dependents: (Legal) (Claimed)
Memberships:
( )VFW ( )BASS Club ( )PTL ( )Moose
( )KKK ( )NRA ( )American Legion ( )Sons of the Confederacy
Length of Right Leg: Length of Left Leg:
Does Your Truck Contain At Least Some Part That Is Painted The Official State Color (Primer Red)? (es ( )No
How Many Cars Do You Have Jacked Up On Blocks In Your Yard?
How Many Kitchen Appliances (Working or Not) Do You Keep On Your Front Porch?
Do You Have A Measurable IQ? ( )Yes ( )No
Do You Usually Wear Doubleknit Polyester Pants With Snags?( )Yes ( )No
Do You Own Any Shoes? ( )Yes ( )No
If Yes, How Many? What Year Did You Last Purchase Shoes?
Are You Married To Any Of The Following:
( )Sister ( )Cousin ( )Sow If Yes, Do You Know Her/Its Name?
Does Your Wife Weigh More Than Your Pickup? ( )Yes ( )No
Can You Sign Your Name And Get The Spelling Right Every Time?
Have You Ever Stayed Sober For A Whole Weekend? ( )Yes ( )No
Can You Count: Past 10 With Your Shoes On? ( )Yes ( )No
To 21 With Your Fly Up? ( )Yes ( )No
Medical Information:
Do You Have At Least 2 Of The Following?
( )B.O. ( )Crabs ( )Runny Nose ( )Trench Mouth ( )Bad Breath
( )Scours ( )Scabies
Do You Know Any Words That Have More Than 4 Letters? ( )Yes ( )No
Have You Ever Had More Than One Bath In A Week? ( )Yes ( )No
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