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NAME: john bubba belcher ADDRESS: 2 bumpyto drive lot 4 CITY: dirtpoorville STATE: se ZIP: xyz HOME PHONE#: phone got disconnected BUSINESS ADDRESS: ain’t got no job FAX #: who’s fax? SOCIAL SECURITY #: 555-2640 DRIVER’S LICENSE #: license taken for dui PHYSICIAN: all them doctors at the er DENTIST: ain’t got no teeth ALLERGIES: red’s fleas, my ol’ lady’s feet, and that stuff that’s in all them dang flowers IN CASE OF EMERGENCY NOTIFY –––––––––––––––––––––––––––––––––––– NAME: Calvin moonshiner jr ADDRESS: 2 drunkto drive lot 3 the boonies se 12300 PHONE NUMBER: he ain’t got no phone neither RELATION TO YOU: brother OR NAME: sandy belcher ADDRESS: same as mine PHONE NUMBER: -------- RELATION TO YOU: fiancé/cousin
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(Added: 2005-04-07 Rating: 3.64 Votes: 14)
Submitted By: -- tc1219@hotmail.com
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