Authors: Ian Frazier
Coyote V. Acme (6 page)
left town?
10.
If any
yes
to
9
, attach blood test and/or billing records.
If any
yes
to
9
, attach blood test and/or billing records.
11.
Have you ever secretly photographed any individual and built a shrine to him/her in your room, house, or place of residence?
Have you ever secretly photographed any individual and built a shrine to him/her in your room, house, or place of residence?
II. ACTUARIAL
All respondents please note that federal law prohibits refusal of coverage for any criterion not specifically outlined in section five of the licensing charter. However, because of statistically higher rates of implausible disappearance for nonwhite protagonists, First Mutual reserves the right to take into account previous storyline in the event of any such character's revival or unlikely return.
1.
Are you a mercenary or former mercenary?
Are you a mercenary or former mercenary?
2.
Are you a former mercenary turned Buddhist monk, police detective, or related occupation?
Are you a former mercenary turned Buddhist monk, police detective, or related occupation?
3.
Have you ever been in a crash?
regular
fiery
Have you ever been in a crash?
regularfiery4.
Have you visited or resided in any of the following countries during the last eighteen months?
Have you visited or resided in any of the following countries during the last eighteen months?
Rio Blanco
San Cristobal
Puerto Grande
Monte Dinero
Suraban
Costa Maria
Santo Stephanico
Los Rios
San Cristobal
Puerto Grande
Monte Dinero
Suraban
Costa Maria
Santo Stephanico
Los Rios
5.
If any
yes
to
4
, state purpose of visit or residence:
stage own kidnapping
other (explain)
If any
yes
to
4
, state purpose of visit or residence:
stage own kidnappingother (explain)6.
Do you own a motorcycle, powerboat (150 hp and over), or purebred stallion/s?
Do you own a motorcycle, powerboat (150 hp and over), or purebred stallion/s?
7.
(Respondents with $10,000,000/yr. personal income only)
(Respondents with $10,000,000/yr. personal income only)
Is private jet equipped with fire extinguisher, smoke detector, and cabin-door latch inhibitor? Do grounds of estate include one or more pits, tunnels, mines, crypts, or permanently sealed rooms?
Is boathouse, bathhouse, gatehouse, or other important outbuilding lit by high-intensity mercury lamps of wattage totalling at least 5000? Does staircase landing adjoin route of access for health-care personnel?
Are gifts and floral displays at wedding reception or similar event subjected to screening by metal detector, X-ray, or thermal neutron analysis device?
Is patio, swim area, and/or moat fenced?
8.
(Respondents under $10,000,000/yr. personal income)
(Respondents under $10,000,000/yr. personal income)
Are you a step-grandniece/nephew?
To the best of your knowledge and belief, do you have any undeclared blood relatives in your town, hospital, place of business, adjacent communities, or other location?
Do you possess valid driver's or chauffeur's license?
Does place of employment have office in Tokyo?
9.
(Twins only)
not fluffy
fluffy
both tabs inside sweater
one tab out of sweater
twisted
outgoing
(Twins only)
Hair
not fluffyfluffyShirt collar
both tabs inside sweaterone tab out of sweaterPersonality
twistedoutgoing10.
(M.D.s, psychiatrists, psychologists, administrators, and physical therapists only)
married
single
(M.D.s, psychiatrists, psychologists, administrators, and physical therapists only)
Are you
marriedsingleIs spouse (if any) an electronics heir/heiress, mercenary or former mercenary, police detective, Buddhist monk, or related occupation?
Have you ever knowingly or unknowingly performed a medical procedure?
Have you recently been the recipient of any testimonial banquets, luncheons, awards, or surprise parties?
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