#71

Form 0919-A

(Rev. October 2012)

Department of Feelings
Internal Regulation Service

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Application for Approval of Crush or Infatuation or Other Quick-Onset Feelings of Attraction

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File this form with Internal Regulation Service

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Section references are to the Internal Regulation Code unless otherwise noted.

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Instructions for completing this form are available at http://www.feelings.irs.gov.

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1a. Name of applicant. Address, City, State, Zip.

1b. Applicant’s telephone number.

1.c. Emotional Identification Number (EIN)

2. Type of Applicant:
◊ Hopeless Romantic
◊ Confirmed Bachelor/Bachelorette
◊ Skeptic

3a. Name of Object. (required) Address, City, Zip (if known)

3b. Object’s telephone number (if known)

3c. Objects’s EIN (if known)

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4. Quick-onset feeling characteristics (mark all that apply)
◊ Giddy or Excited         ◊ Hopeful
◊ Curious                        ◊ Confused
◊ Bemused                     ◊ Nervous
◊ Other _______________________________

5. Interaction types completed or planned (mark all that apply)
◊ Phone call
◊ Text message
◊ Brief in person meeting
◊ Sustained in person meeting
◊ Extended in person meeting
◊ Letter
◊ Social Media or other messaging app
◊ Other _______________________________

6. Level of minute-to-minute distraction
◊ Mild
◊ Moderate
◊ Severe
◊ Extreme

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Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature ________________________

Date _____________________________

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For Privacy Act and Heartbreak Reduction Act, see Form 09-19A Instructions

 

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Drawing by Yael Kisel