1. House address: 2. Is this house on a farm (or ranch)? 3. If no in item 2: Is this house on a place of three or more acres?
For All Persons:
4. Name (last name first): Futatsuiwa Mamizou
· What is the name of the head of household? Keith-san would be, I think. · What are the names of all other persons who live here? · List in this order: - The head: Keith Goodman - His wife: Aoife - Unmarried sons and daughters and their families (in order of age): Trucy Wright - Married sons and daughters and their families: - Your least favorite color: None!
5. Species (underline applicable):
Human (H) Animal (A) Animal youkai, actually. Communist (☭) Wizard (W) Catgirl (CG) God/Goddess (G) Other (please specify)
6. Sex (underline applicable):
Male (M) Female (F)
7. Are you now married, widowed, divorced, separated, or never married? (Mar, Wd, D, Sep, Nev)
8. What State (or foreign country) were you born in? Sado Island, Japan
9. What is your deepest secret? Once I got terribly drunk and couldn't remember anything the next day.
Actually, that's happened to me several times, so I suppose that's not much of a secret.
10. If foreign born: Are you naturalized? (Yes, No, or AP for born abroad of American parents) What on earth does "naturalized" mean?
11. What are you most ashamed about? I have never been ashamed of anything!
For Persons 14 Years of Age and Over:
12. What were you doing most of last week: working, keeping house, or something else? (Wk, H, Ot, or U for unable to work) U since apparently you think I'm a dog.
13. If H or Ot in Item 12: Did you do any work at all last week, not counting work around the house? (Include work for pay, in own business, profession, on farm, or unpaid family work) (Yes or No)
14. If No in Item 13: Were you looking for work? (Yes or No)
15. If No in Item 14: Even though you didn't work last week, do you have a job or business? (Yes or No)
16. If No in Item 15: Do you have a good explanation for why you are being so utterly useless to the prosperity of our great town? (Yes, Female, or No, elaborate. Yes is not a valid answer.)
For All Persons:
17. What country were your father and mother born in? (Enter US or name of Territory, possession, or foreign country)
Father: Japan Mother: Japan
18. If anything but America in Item 17, justify your right to be here (maximum 100 words): Well, you did bring me here, didn't you?
19. What is your most embarrassing memory? Nothing will embarrass you if you embrace life and live it to the fullest!
20. What is more important- laughter (L) or medicine (M)? Both are important in their own ways, I'd say.
21. Please list all of the following diseases you have been afflicted by, if any: Measles (M), Mumps (U), Chicken-Pox (C), Polio (P), Tuberculosis (T), Smallpox (S), Communism (R) None of these!
For All Males in the Household:
22. Did you ever serve in the U.S. Armed Forces during (specify Y or N):
22a. World War II
22b. World War I
22c. Any other time, including present service
23. If No to any question in Item 22, justify your reasons for being so reprehensibly unpatriotic (maximum 100 words):
24. Are you a Communist? Are you?
For All Persons:
25. Is there an afterlife and how do you know this isn't it? (maximum 100 words) I'm sure there is, and apparently the Yama says so although I've still yet to meet her.
no subject
1. House address:
2. Is this house on a farm (or ranch)?
3. If no in item 2: Is this house on a place of three or more acres?
For All Persons:
4. Name (last name first): Futatsuiwa Mamizou
5. Species (underline applicable):
6. Sex (underline applicable):
7. Are you now married, widowed, divorced, separated, or never married? (Mar, Wd, D, Sep, Nev)
8. What State (or foreign country) were you born in? Sado Island, Japan
9. What is your deepest secret? Once I got terribly drunk and couldn't remember anything the next day.
Actually, that's happened to me several times, so I suppose that's not much of a secret.
10. If foreign born: Are you naturalized? (Yes, No, or AP for born abroad of American parents) What on earth does "naturalized" mean?
11. What are you most ashamed about? I have never been ashamed of anything!
For Persons 14 Years of Age and Over:
12. What were you doing most of last week: working, keeping house, or something else? (Wk, H, Ot, or U for unable to work) U since apparently you think I'm a dog.
13. If H or Ot in Item 12: Did you do any work at all last week, not counting work around the house? (Include work for pay, in own business, profession, on farm, or unpaid family work) (Yes or No)
14. If No in Item 13: Were you looking for work? (Yes or No)
15. If No in Item 14: Even though you didn't work last week, do you have a job or business? (Yes or No)
16. If No in Item 15: Do you have a good explanation for why you are being so utterly useless to the prosperity of our great town? (Yes, Female, or No, elaborate. Yes is not a valid answer.)
For All Persons:
17. What country were your father and mother born in? (Enter US or name of Territory, possession, or foreign country)
18. If anything but America in Item 17, justify your right to be here (maximum 100 words): Well, you did bring me here, didn't you?
19. What is your most embarrassing memory? Nothing will embarrass you if you embrace life and live it to the fullest!
20. What is more important- laughter (L) or medicine (M)? Both are important in their own ways, I'd say.
21. Please list all of the following diseases you have been afflicted by, if any: Measles (M), Mumps (U), Chicken-Pox (C), Polio (P), Tuberculosis (T), Smallpox (S), Communism (R) None of these!
For All Males in the Household:
22. Did you ever serve in the U.S. Armed Forces during (specify Y or N):
23. If No to any question in Item 22, justify your reasons for being so reprehensibly unpatriotic (maximum 100 words):
24. Are you a Communist? Are you?
For All Persons:
25. Is there an afterlife and how do you know this isn't it? (maximum 100 words) I'm sure there is, and apparently the Yama says so although I've still yet to meet her.