Congratulations on having been selected for the Long-Probe B form of the United States Census. Remember: filling out the form is non-compulsory, but failure to submit may result in an income tax audit, foreclosure on all property, and Department of Justice agents egging your home. Also, remember: census data can only be used in arranging voting districts, allocating public money, and singling-out undesirables. This data cannot be redistributed to other government agencies, sold to direct-mailing companies, or passed around the office to amuse census workers and their friends.

Name:

Name used in underage porn chat rooms:

Occupation:

Gender (original): M F

How much did you earn last year?

How much did you claim you earned on last year's tax forms?

I pay my Federal Income Tax:
Sometimes Occassionally Never

Are you or have you ever been a member of a(n):

If so, enter name and contact info:

Are you an illegal alien? Yes No

Do you know any illegal aliens? Yes No

Do you listen to Ricky Martin
in English or in Spanish?

Do you own a bathtub? Yes No

How often do you bathe? Daily Weekly

Whenever the illegal aliens in my bathtub complain about the smell.

When you have completed the form, please submit. submit

 
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