Boro Park DMV
Please answer the following questions IN ENGLISH to the best of your ability.
No yiddish responses.
Last name*: ________________
*if you go by your last name as your first name (ie, Goldberg) then write the other name.
* If longer than 15 characters, shorten it already
First name:____________ ben ___________
[_] Chaim Yosef [_] Sarah Leah
[_] Yosef Chaim [_] Racheli Leah
[_] Yosef Chaim Yossie [_] Leah Leah
[_] Menachem Mendel [_] Bracha Bina
[_] Yizchak Isaac [_] Bina Bracha Tova
[_] Dov Bear [_] Chava Nagila
[_] Sid/Lou/Max [_] Sarah Rivka Rachel Leah
Middle Name: _____ (If you have more than 5 middle names, leave blank)
Hebrew Birthday ________
Secular Birthday (‘summer’ is not an answer) _____
Age: ____ (if unsure or don’t want kids/wife to know, leave blank or scribble)
Names of connections you have at DMV/City Hall:
_______ _______ ________
_______ _______ ________
Do you drive with a hat or shaitel on? _____
Hat Size/Maker: ____/______
While waiting at a red light, do you:
___ learn – if yes, what sefer/daf?_____
___adjust shaitel/ make-up
___daven (women only)
___ talk to your mother – if yes, what topic: (shopping, gossip, weddings, what to wear)
___ talk to your rebbe – if yes, what topic: (halachic shaiyla, relationship, money, halachos of dating and money, shul politics)
Spouse’s Name: ______________________ bas________
Shver’s Name/Address/Fax: __________________
Shver’s occupation/ salary for you: __________________
Rebbe’s Name: _______________________
(Lenient) Rebbe’s Name: ___________________
Yichus: ___________________ ______ _______ ______
Yeshivos your learned by _______________ _____ _____ _____ (4 max)
Award honors from shul/yeshiva: _________________ year______
Occupation:
[_] Hocker (cellphones)[_] Diamonds (Belgium/Tel Aviv) [_] Accounting [_] Import/Export Wholesale [_] Rabbi/Teacher [_] Rebbetzin/Therapist [_] CEO (unknown industry) [_] Father-In-Law’s Biz [_] Social Work [_] Lawyer/Rabbi [_] Doctor
[_] Son is a doctor
Number of children living in household: ___
Number of anacles living in Israel: ___
Number of grandchildren living in household: ___
Number of bochurim staying by you for the yeshiva_____
Number of kiddushes sponsored by you (shalosh seudos included)____
Education: 6,7,8 (Circle highest grade completed before going to learn full-time)
If higher education what was your major?
[_] 9th grade [_] 10th grade
Do you [_] Own [_] Rent your mobile phone? What kind and how much do you pay per month______ /$_______
___ Total number of vehicles you own
___ Number of carpools your drive daily
___ Total number of vehicles you borrow from your neighbor to do errands before shabbos
___ Number of station wagons you have at the garage
___ Total number of convertibles you’ve rented when visiting a hot place (LA, Florida, Vegas) for a chasunah
___ Number of SUVs you own
___ Number of Uncle Moshe tapes you have in front seat
___ Number of Loshon Hora bumper stickers
___ Number of Golan bumper stickers
___ Number of times you’ve wanted to kill Kivi and Tooky
___ Number of Chus-Bus trips you take a week
What camps did you go to (Mogen Av/Sternberg only.) ______ _______
you will receive further correspondence and discounts from our business partners/relatives? Yes? K, now take a number and wait online. Have a good shabbos. Next.