2010 Census for Southeast Texas

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:______________________
Lover’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:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed

Model and year of your pickup: 196_

Do you have a gun rack?
(_) Yes (_) No; If no, please explain:

Newspapers/magazines 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?

Don't Mess With Old White Guys

Some of the language in this video may be offensive so there is your warning. There are times when you have to root for the old white guy when he didn't do anything wrong to start with.

Bob