12. Number of children living in household:_____ |
13. Number of children living in shed:______ |
14. Number of children that are yours:______ |
15. Mother's Name:__________________ |
16. Father's Name:__________________(If not sure, leave blank) |
17. Education: 1 2 3 4 (Circle hightest grade completed) |
18. Do you ___own or ___rent your mobile home? (Check appropriate space) |
19. Vehicles you own and where you keep them: |
___Total number of vehicles you own |
___Number of vehicles that still run |
___Number of vehicles in front yard |
___Number up on blocks |
___Number of vehicles in neighbor's front yard |
___Number of vehicles in neighbor's front yard up on blocks |
19. Number of firearms you own:_______ |
20. Model and year of your pickup truck:____________ |
21. Do you have a gun rack? |
___Yes |
___No |
If no, please explain in detail on back of form |
22. Newspapers/magazines you subscribe to: |
___The National Enquirer |
___The Globe |
___TV Guide |
___Soap Opera Digest |
___Rifle and Shotgun |
23. Number of times you have seen a UFO:____ |
24. Number of times you have seen Elvis:____ |
25. Number of times you have seen Elvis in a UFO:___ |
26. How often do you bathe: |
___Weekly |
___Monthly |
___Not applicable |
27. How far is your home from a paved road? |
___1 mile |
___2 miles |
___Don't know |