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September 03, 2003
Application Form
Received via email:
Application To Date My Daughter
Name: Last:_________________First____________ M.I.:___ Age:_____
Address:___________________________ County:_____________________
Religion:_______________ # of attendances in the last year______
Parent:Father's Name__________#of marriages____# of affairs_____
Mother's Name__________#of marriages____# of affairs_____
Address:_________________________________________________
________________________________________________________________
1. Do you own or drive a van? (If so, please discontinue
filling out form)______________________
2. In 50 words or less, describe what NO!!! means to you?______
____________________________________________________________
3. In 50 words or less, describe what LATE means to you?_______
____________________________________________________________
4. Where would you least like to be shot?______________________
5. Which is the last bone you want broken?_____________________
6. What do you want to be IF you grow up?______________________
7. The place for a woman is____________________________________
8. What is my daughter's name__________________________________
9. Who besides God should you fear the most?___________________
10. Is there a history of insanity in your family?______________
11. Have you or any member of your family ever spent time in
jail?_______________________________________________________
12. Are your parents closer relatives to each other than first
cousins?____________________________________________________
________________________________________________________________
Parent's Use Only
Appearance (Looks Like) Status
Mel Gibson___________ Accepted:____________
David Letterman___________ Pending:_____________
Pee Wee Herman____________ Rejected:____________
Posted by Peskie at September 3, 2003 12:00 PM