MOUNTAIN =
REGIONAL 2020 FEDERAL CENSUS
Last name: =
________________
First name: =
(Check appropriate box)
(_) =
Billy-Bob
(_) =
Billy-Joe
(_) =
Billy-Ray
(_) =
Billy-Sue
(_) =
Billy-Mae
(_) =
Billy-Jack
What does =
everyone call you?
(_) =
Booger
(_) =
Bubba
(_) =
Junior
(_) =
Sissy
(_) =
Other___________________
Age: ____ (if =
unsure, guess)
Sex: ____ M =
_____ F _____ Not sure
Shoe Size: =
____ Left ____ Right
Occupation: =
(Check appropriate box)
(_) =
Farmer
(_) =
Mechanic
(_) Hair =
Dresser
(_) =
Unemployed
(_) Dirty =
Politician
(_) =
Preacher
Spouse’s =
Name:_________________________
2nd Spouse’s =
Name:______________________
3rd Spouse’s =
Name:______________________
Relationship =
with spouse: (Check appropriate box)
(_) =
Sister
(_) =
Brother
(_) =
Aunt
(_) =
Uncle
(_) =
Cousin
(_) =
Mother
(_) =
Father
(_) =
Son
(_) =
Daughter
(_) =
Pet
Number of =
children living in household:___
Number of =
children living in shed: ______
Number that =
are yours: ______
Mother’s =
Name:______________________(If not sure, leave =
blank)
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: ___
Firearms you =
own and where you keep them:
&nb=
sp; ____ truck
&nb=
sp; ____ bedroom
&nb=
sp; ____ bathroom
&nb=
sp; ____ kitchen
&nb=
sp; ____ shed
Model and year =
of your pick-up: 196_
Do you have a =
gun rack? (_) Yes (_) No; If no, please explain:
Newspapers/maga=
zines you subscribe to:
(_) The =
National Enquirer
(_) The =
Globe
(_) TV =
Guide
(_) Soap =
Opera Digest
(_) Rifle and =
Shotgun
Number of =
times you’ve seen a UFO:_____
Number of =
times in the last 5 years you’ve seen =
Elvis:_____
Number of =
times you’ve seen Elvis in a UFO:_____
How often do =
you bathe:
(_) =
Weekly
(_) =
Monthly
(_) Not =
Applicable
Color of =
eyes:
Left______ =
Right_____
Color of =
hair:
(_) =
Blond
(_) =
Black
(_) =
Red
(_) =
Brown
(_) =
White
(_) =
Clairol
=
Color of teeth:
(_) =
Yellow
(_) =
Brownish-Yellow
(_) =
Brown
(_) =
Black
(_) =
N/A
Brand of =
chewing tobacco you prefer:
=
(_)Red-Man
How far is =
your home from a paved road?
(_) 1 =
mile
(_) 2 =
miles
(_) just a =
whoop-and-a-holler
(_) =
road?
~~
Dr Bob Griffin =
[email protected] =
www.grif.net
"Jesus =
Knows Me, This I Love!"