REQUEST FORM FOR MIKE'S SECRET RECIPE FOR

 

HOTSY TOTSY CHILI

 

Name____________________________________

 

Address__________________________________

 

I.Q. _________________________

 

Mother's Maiden Name (For your Obituary)________________

 

Your Race (please circle one or more)

Human

Caucasian  

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.)

___Legal  

___Illegal  

___Not Sure 

___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.

American Indian

India Indian

Cleveland Indian

African

Other(s) ______________________________________

 

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

___Just curious

___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?

Yes     No

 

Do you have an adequate supply of fire extinguishers? Yes  No

 

Are You Allergic To Any Of The Following Chili Ingrediants: (Please indicate)

___Battery acid

___Lye

___Sani Flush Toilet Bowl Cleaner

___Nitro Glycerin

___Gasoline

___The color red

___Smoke

___Heat

___Open flame

___Other

 

Please Indicate your Next of Kin__________________

 

Do you have a life insurance policy? 

___Yes

___No

___Should I have?

 

Do you have health insurance? 

___Yes 

___No

___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?

___Yes

___No

___Not sure

 

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.

 

Signature____________________________

 

Co Signer______________________________

 

Witness______________________________

 

Witness______________________________

 

Witness______________________________

 

Witness______________________________

 

First Notary Public  Seal

 

Second Notary Public Seal

 

Date_______________

 

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.