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Application Form to marry an Ugly Millionaire

Name of the Millionaire you wish to marry

Your Name    Your Age    

Area where you live

Your Occupation   

Your Hobbies

What is your:  Height  Weight Eye Color

Do you smoke

Do you take illegal drugs

Do you have any criminal convictions

Have you previously been married?  

Rate yourself on a scale of 1 to 10 on the following: (10 being the best)