Name: ________________
(last)
(_) Billy-Bob
(_) Billy-Joe
(_)Billy-Ray
(_)Billy-Sue
(_)Billy-Mae
(_)Billy-Jack
(Check appropriate box)
Age: ____
Sex: ____ M _____ F _____ N/A
Shoe Size: ____ Left ____ Right
Occupation:
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Un-employed
Spouse's Name: __________________________
Relationship
(
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