REQUEST FORM FOR MIKE'S SECRET RECIPE FOR
HOTSY TOTSY CHILI
Mother's Maiden Name (For your Obituary)________________
Your Race (please circle one or more)
Colored (Please indicate color(s) _____________)
Russian (I do not give my recipe to Communists)
Chinese (I do not give my recipe to Communists)
Democrat (I do not give my recipe to Communists)
Mexican (Please indicate your residency status.)
___Check with the INS
Note: If you are Mexican and can not read English, please stop filling out out this form at this point and destroy the entire form.
Please Indicate The Reason(s) Why You Are Requesting My Secret Recipe:
___It sounds delicious
___I'm a masochist who has no respect for my body
___I'm as crazy as you are (I'll bet you aren't)
___I was planning to replace my range and all my kitchen wall paint anyway
___I am feeling suicidal
Are you willing to contact your local EPA Office for instructions on how to properly dispose of hazardous waste?
Do you have an adequate supply of fire extinguishers? Yes No
Are You Allergic To Any Of The Following Chili Ingrediants: (Please indicate)
___Sani Flush Toilet Bowl Cleaner
___The color red
Please Indicate your Next of Kin__________________
Do you have a life insurance policy?
___Should I have?
Do you have health insurance?
___I don't need to pay for health insurance because I'm voting Democrat next November.
Have you made out your last Will and Testament?
Please read and sign the following agreement:
Wheras, whereby, hereby, and to wit: The party of the first party hereby and whereby holds the party of the second party and/or the birthday party incognito and not responsible for the second party of the first party. I also hereby agree that the third party of the first and second party whereby the first and second, or third party, if applicable, will not engage in any activity involving the second, first, third, forth (if any) party on or in any premises or premise, including, but not limited to, domicile, commercial, private enterprise, or government sponsored activities both foreign and domestic or the equivalent thereof and/or any other activity or activities thereof. I further agree that any other party, or activity thereof, or group, thereof, or any third party, thereof, that I will not engage in any activity or activities thereof, which would put the first party, or parties thereof in any compromising agreement or agreements including contracts either oral, verbal, or written which would reflect on the first or second, if any, parties who plan or willfully not plan to engage any other party or parties thereof.
First Notary Public Seal
Second Notary Public Seal
Please completely fill out this form with honest and truthful answers and send it to me in a plain brown envelope. Because I have always had difficulty making decisions, please allow from 6 – 8 years before I notify you as to my approval or disapproval of your request.