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| − | '''DATA FOR SENSITIVE OR CRITICAL-SENSITIVE POSITION'''<br> | + | '''The 1966 Fanzine Questionnaire''' |
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| − | '''IMPORTANT: INSTRUCTIONS'''<br>
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| − | This form must be completed in duplicate. Use dark legible pen or typewrite if possible. Make sure all questions have been answered to the fullest extent of your memory's capacity and/or imagination ''where applicable.'' Complete ''all'' items ''except'' No. 28. If an answer to any item is "no" or "none" so state. Any items that for personal reasons you wish to remain confidental leave blank.<br>
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| − | Item 17A. pertains to type of licenses or certificates in possession.<br>
| + | '''What is your full name?'''<br> |
| | + | Francis Vincent Zappa, Jr. II (the secon menas junior which means I have the same name as my father.) |
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| − | After you have filled out this form in duplicate place one copy with your records in a ''safe place'' and send the other copy to United Mutations, Box 23315, Hollywood, California 90028 along with a suitable photograph or photographs and any other material which you ''feel'' may be necessary.
| + | '''Where and when were you born?'''<br> |
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| + | December 21, 1940 on Baltimore. Maryland. |
| − | 1. Photo
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| + | '''How tall are you, what do you weigh, what is your coloring?'''<br> |
| − | 2. Social Name
| + | Six foot tall and 135 pounds. Doce grey complexion, jet black hair, jet brown eyes, jet pink gums – the rest all matches. |
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| − | 3. Name at birth ''(First, middle, last)''
| + | '''Do you have brothers and sisters?'''<br> |
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| + | Yes. A sister named Candy, and two brothers – Carl and Bobby. They all lived. |
| − | 4. Address of correspondence ''(Number, Street, State, and Zip code)''
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| + | ... |
| − | 5. Home phone No.
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| − | 6. Height
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| − | 7. Weight
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| − | 8. Sex
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| − | 9. Marital status
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| − | 10. Birthplace
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| − | 11. Birth date
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| − | 12
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| − | 13. Profession ''If student so state''
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| − | 14. Place of Emplyment if presently emplyed ''University or school if student''
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| − | 15. Position
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| − | 16. Description of work
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| − | '''17. FOREIGN TRAVEL'''<br>
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| − | Have you ever lived or traveled through any foreign city/states throughout the Continental United States? ''explain in detail)''
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| − | '''17. SPECIAL QUALIFICATIONS AND SKILLS'''<br>
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| − | A. Licenses or certificates
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| − | E. Special skills you possess and machines and equipment you can use
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| − | F. Special qualifications not covered in application ''(For example, your most important publications; your patents or inventions; membership in professional or scientific societies, etc.; honors and fellowships received.)''
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| − | '''21. EDUCATION''' | |
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| − | A. State major field of study at highest level of education
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| − | B. Most enlightening revelation brought about ''through'' highest level of education ''(in less than five words please)''
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| − | C. Most enlightening regulation maintained by educational facility ''(use as many words as you please)''
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| − | TRUE OR FALSE -- PLACE X IN PROPER COLUMN -- YES - NO
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| − | 23. Have you ever had a nervous breakdown?
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| − | 25. Have you ever had an allergic reaction to pemiculin?
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| − | 26. Have you ever been arrested, taken into custody, held for investigation or questioning, or charged by any law enforcement authority? (Do not omit: (1) Traffic violations for which you paid a fine of $30.000 or less, (2) Minor petty larcenies, (3) Major petty larcenies, (4) Anything that happened before your 6th birthday. All incidents must be included, even though they were dismissed or you ''merely'' forfeited collateral.)<br>
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| − | 27. While in the military service were you ever arrested for an offence which resulted in a trial by deck court or by summary, special, or general court-martial?<br>
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| − | ''If your answer to 26, or 27, is "yes" give details in item 39, showing form each incident (1) date, (2) charge, (3) place, (4) law enforcing authority or type of court or court-martial, and (5) action taken.
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| − | 28. ''Furs'' are articles made of fur on the hide or pelt and articles of which such fur is worth more than three times as much as the next most valuable component.
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| − | 29. The first digit of my area code is 6.
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| − | 30. A citizen of Pennsylvania may sue the state of New Jersey in a federal court.
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| − | 31. Considering the average for my sex I wear my hair.
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| − | 32. The most unusual film on our program , now or ever, is Ted Browning's FREAKS. Browning, a master of the macabre, created the imperishable ''Dracula'' with Bela Lugosi and ''The Unholy Three'' with Lon Chaney.
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| − | 33. Mothers is good.
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| − | '''PERSONALITY TRAITS'''
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| − | 34. My favorite kind of ravioli is
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| − | 35. My favorite hobby is
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| − | 36. My favorite music is
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| − | 37. Favorite color
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| − | 38. Favorite smell
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| − | 39. My favorite confrontation with authority
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| − | 40. My favoritest place
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| − | 41. Favorite contemporary artist(s) ''Visual, environmental or cinema
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| − | 42. Favorite predecessor
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| − | 43. Favorite Dadist and/or surrealist
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| − | 44. Favorite contemporary musician(s) ''group(s)
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| − | 45. Favorite well known personage
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| − | 46. Favorite movie
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| − | 47. Favorite form of recreation
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| − | 48. Favorite flavor ice cream ''if you don't like ice cream your favorite piece of apparel
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| − | 49. Fave rave
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| − | 50. Favorite other stuff
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| − | SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS. Indicate item numbers to which answers apply.
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| − | Signature ''(sign in ink)'' Date
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| | [[Category:Articles by Zappa]] | | [[Category:Articles by Zappa]] |
The 1966 Fanzine Questionnaire
What is your full name?
Francis Vincent Zappa, Jr. II (the secon menas junior which means I have the same name as my father.)
Where and when were you born?
December 21, 1940 on Baltimore. Maryland.
How tall are you, what do you weigh, what is your coloring?
Six foot tall and 135 pounds. Doce grey complexion, jet black hair, jet brown eyes, jet pink gums – the rest all matches.
Do you have brothers and sisters?
Yes. A sister named Candy, and two brothers – Carl and Bobby. They all lived.
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