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): Elizabeth
· What is the name of the head of household? · What are the names of all other persons who live here? · List in this order: - The head: Some new fellow, he probably won't last - His wife: Elizabeth - Unmarried sons and daughters and their families (in order of age): - Married sons and daughters and their families: - Your least favorite color: What is the color of despair?
5. Species (underline applicable):
Human (H) Animal (A) Communist (☭) Wizard (W) Catgirl (CG) God/Goddess (G) Other (please specify) I do not know what I am, merely that I server the master in the Velvet Room
6. Sex (underline applicable):
Male (M) Female (F)
7. Are you now married, widowed, divorced, separated, or never married? (Mar, Wd, D, Sep, Nev) The town would see me as married, but this is the maw of Erebus
8. What State (or foreign country) were you born in? I was born in a different state of consciousness
9. What is your deepest secret? I know not what I am, yet that is not a secret. Perhaps it is that I know not how to keep such things as secrets.
10. If foreign born: Are you naturalized? (Yes, No, or AP for born abroad of American parents) I am not even sure I am natural.
11. What are you most ashamed about? That I may not have the power to best Erebus.
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) Wk
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: While I have brothers and sisters, I do not know if I have a father. Mother: As is the same with a mother, though perhaps I do, it is lost to me.
18. If anything but America in Item 17, justify your right to be here (maximum 100 words): I am where my contract stipulates, for the only reason I am out of the master's domain is my contract.
19. What is your most embarrassing memory? Knowing when I had to return to the room, so that I not loose sight of my duties.
20. What is more important- laughter (L) or medicine (M)? Laughter, as it is brought about by joy.
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)
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 have seen the other side.
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): Elizabeth
5. Species (underline applicable):
6. Sex (underline applicable):
7. Are you now married, widowed, divorced, separated, or never married? (Mar, Wd, D, Sep, Nev) The town would see me as married, but this is the maw of Erebus
8. What State (or foreign country) were you born in? I was born in a different state of consciousness
9. What is your deepest secret? I know not what I am, yet that is not a secret. Perhaps it is that I know not how to keep such things as secrets.
10. If foreign born: Are you naturalized? (Yes, No, or AP for born abroad of American parents) I am not even sure I am natural.
11. What are you most ashamed about? That I may not have the power to best Erebus.
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) Wk
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): I am where my contract stipulates, for the only reason I am out of the master's domain is my contract.
19. What is your most embarrassing memory? Knowing when I had to return to the room, so that I not loose sight of my duties.
20. What is more important- laughter (L) or medicine (M)? Laughter, as it is brought about by joy.
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)
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 have seen the other side.