This form is for demonstration purposes only.

Title Not Supplied.

Information
Last Name First Name MI
Date of Birth Social Security Number License Number  
Information
Street Address (including suite number, etc. if applicable)
City County Zip Code Date of Purchase  
Random Declarations
I have never checked a checkbox on a form before today.
I probably will not ever check on again.
I think that these declarations are stupid.
I have almost certainly made more inane statements or promises.
I have never made such stupid statements on a government form.
That last statement does not include federal tax statements.
Bank security questions are the most insecure thing in the history of history.
I love Brussel sprouts.
This whole thing is stupid.
The only thing that is more stupid than this is Dumb and Dumber To.
I haven’t watched that movie, but it seemed like a pretty safe statement after watching the first one.
I swear under penalty of perury that this is the single stupidest form I’ve ever laid eyes upon, and that I have examined every jot and tittle of this document, and there are exactly two errors.
Affirmation
Signature First Name