Challenge: Government 2 buck Rebate form

[W0LB0T]

Please fill out this form and return it to the inconspicuous government office in a very dubious location surrounded by a complete lack of car parks and no public transport, between the hours of 11:11 am to 11:12 am. This form must be completed while standing on the roof of the applicant’s resident’s roof.

Question 1
Name (____________________________)
Maidens name(______________________)
Maids name(________________________)
Cats name(_________________________)
Cars name(_________________________)

Question 2
Age(___)
Fill this square if Age is a prime number (___)

Question 3
Date of birth(__,__,__)
Date of barrys birth(__,__,__)
Mate of smurf(__,__,__)
Slate of myrth(__,__,__)

Question 4
Address(__________________________________________ __________________)
If you’re lying fill address ....
.....
....
...
..
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here(__________________________________________)

Question 5
Phone number(__________)
Mobile phone number (__________)
CB radio Frequency(__________)
Can with string number(__________)

Question 6
Your really important number you forget all the time(___________________)
The cousin you don’t like who lives in some place but you still have to talk to the jerks really important number you forget all the time (____________________)
Barry’s really important number you forget all the time (____________________)

Question7
Are you slighty tall but not too tall but almost tall with some hair on head with feet the shape of basketballs yes(_) no (_)
If yes proceed to question 8
If no then why are you not (_______________________)

Question 8
Signature(_____)
Barrys signature(_______)
King of englands signature(______)
Today’s date(__,__,__)
Yesterdays date(__,__,__)
Your first date(______________)
Was he or she go off like a firecracker in the sack: YES(_) NO (_)
Have you filled out this form to the best of your ability: FUDGE NO(_)

[TalHex]

can i be exempt from filling it out? i'm a kitsune after all so the same medical proceedures don't apply to me... fucking vet...