GENWiki

		  NIGGER APPLICATION FORM
   (photo not required since you all look alike anyway)

 1) Date___/___/___
 2) Address __________________________
 3) If living in auto, give make ,model & liscense #
     _______________________________________________________

 4)Name of mother _____________________________
 5)Name of fatha (if known)_____________________________
 6)Name of auto :	CADILLAC :____ - IMPERIAL :_____ LINCOLN :____
			CONTINENTAL:____ - OTHER :____________
 6.2) is your car : FINANCED :_______ or STOLEN :______
 6.3) If financed what is repossesion date ?_____/____/____
 7) Marital status: Common law :__________   Pimp :________
		    Shack up :__________  Other :________
 8) Approximate estimation of income   THEFT:______________
				       RELIEF:______________
    (if you do not know how -	       WELFARE:______________
	  to add then steal a	 -     UNEMPLOYMENT:______________
   calculator ) 		       TOTAL:______________

  9)  Place of birth:	CHARITY HOSPITAL:_______________
			FREE PUBLIC HOSPITAL:______________
			BACK ALLEY:__________ ZOO:______________
			COTTON PATCH:_____________ OTHER______________
  10) How many words do you jive a minute?_______________
  11) Check machines you can operate:	    CROW BAR:()
				     PINBALL MACHINE:()
				      STRAIGHT RAZOR:()
				       RECORD PLAYER:()
				      RUBBER MACHINE:()
				 OTHER (Please specify)_______________

12) Check foods that you like best:  BBQ:() FRIED CHICKEN:() CARP:() COON:()

MUSKRAT:() WATERMELON:() ALL OF ABOVE:()

13) Check Illnesses you have had in the last year:  MEASELS:() MUMPS:() V.D:()

FOOD STAMP POISON:() OTHER (Please specify)_

14) Abilities:  GOVERNMENT EMPLOYEE:() EVANGELIST:() DEMONSTRATION LEADER:()

V.D. SPREADER:() RAPIST:() UNEMPLOYMENT BUREAU WORKER:() USED HUBCAP SALESMAN:() WATERBED DEMONSTRATOR:() WELFARE RECEIVER:() OTHER:(Please explain) 15) How many kids do you have?: 1st Wife:_ 2nd Wife:_ 3rd Wife:_ Neighbor's Wife:_ Shack-ups:_

16) In 50 words or less, explain your desires in life (other than a white

girl…)