56 lines
2.3 KiB
Plaintext
56 lines
2.3 KiB
Plaintext
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NIGGER APPLICATION FORM
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(photo not required since you all look alike anyway)
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1) Date___/___/___
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2) Address __________________________
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3) If living in auto, give make ,model & liscense #
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_______________________________________________________
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4)Name of mother _____________________________
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5)Name of fatha (if known)_____________________________
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6)Name of auto : CADILLAC :____ - IMPERIAL :_____ LINCOLN :____
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CONTINENTAL:____ - OTHER :____________
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6.2) is your car : FINANCED :_______ or STOLEN :______
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6.3) If financed what is repossesion date ?_____/____/____
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7) Marital status: Common law :__________ Pimp :________
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Shack up :__________ Other :________
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8) Approximate estimation of income THEFT:______________
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RELIEF:______________
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(if you do not know how - WELFARE:______________
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to add then steal a - UNEMPLOYMENT:______________
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calculator ) TOTAL:______________
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9) Place of birth: CHARITY HOSPITAL:_______________
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FREE PUBLIC HOSPITAL:______________
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BACK ALLEY:__________ ZOO:______________
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COTTON PATCH:_____________ OTHER______________
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10) How many words do you jive a minute?_______________
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11) Check machines you can operate: CROW BAR:()
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PINBALL MACHINE:()
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STRAIGHT RAZOR:()
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RECORD PLAYER:()
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RUBBER MACHINE:()
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OTHER (Please specify)_______________
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12) Check foods that you like best: BBQ:() FRIED CHICKEN:() CARP:() COON:()
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MUSKRAT:() WATERMELON:() ALL OF ABOVE:()
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13) Check Illnesses you have had in the last year: MEASELS:() MUMPS:() V.D:()
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FOOD STAMP POISON:() OTHER (Please specify)_________________________
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14) Abilities: GOVERNMENT EMPLOYEE:() EVANGELIST:() DEMONSTRATION LEADER:()
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V.D. SPREADER:() RAPIST:() UNEMPLOYMENT BUREAU WORKER:() USED HUBCAP
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SALESMAN:() WATERBED DEMONSTRATOR:() WELFARE RECEIVER:() OTHER:(Please
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explain)______________________________
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15) How many kids do you have?: 1st Wife:___ 2nd Wife:___ 3rd Wife:___
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Neighbor's Wife:___ Shack-ups:___
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16) In 50 words or less, explain your desires in life (other than a white
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girl...)
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________________________________________________________________________________
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____________________________
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____________________________________________________________
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