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ri: MARITAL AND DEPENDENCY INFORMATION: CONTINUED (uu need addi

mal space, use It

Gadi One ROLE MSE Le

FURNISH THE FOLLOWING INFORMATION ABOUT EACH OF YOUR MARRIAGES (IF NOT APPLICABLE, WRITE "N/A")
28A. DATE AND PLACE OF MARRIAGE

DATE AND PLACE TERMINATED
288. TO WHOM MARRIED 28C. TERMINATED | | 280

(Death, Divorce)
MONTH, YEAR | City, STATE .

MONTH, YEAR CITY, STATE

FURNISH THE FOLLOWING INFORMATION ABOUT EACH PREVIOUS MARRIAGE OF YOUR PRESENT SPOUSE (IF NOT APPLICABLE, WRITE "N/A")
29A. DATE AND PLACE OF MARRIAGE.

206,70 WHOM MARRIED 29C. TERMINATED 29D. DATE AND PLACE TERMINATED
(Death, Divorce)
MONTH, YEAR CITY, STATE

MONTH, YEAR CITY, STATE

DEPENDENCY - Dependent Children Information (Ifyou need additional space, use Item 45 "Remarks
FURNISH. THE FOLLOWING INFORMATION FOR EACH OF YOUR DEPENDENT CHILDREN

300. CHECK EACH APPLICABLE CATEGORY
30A, NAME OF CHILD | 908 DATE & PLACE OF | a0 social SECURITY =
First, ida nite, ft) | cp, ane or country) NUMBER lsiococica| aooereD |stePcHLo|oup ANON) oisaaled _|pREviousLY
ie SCHOOL _|BEFORE AGE 18| MARRIED
(Month, day, year) oO: Go oO oO oO oO
Place:
(Month, day, year) Oo oO O O O Oo :
$
Place: :
(Month, day, year) : | oO o oO oO O O
Place:
FURNISH THE FOLLOWING INFORMATION FOR EACH OF YOUR DEPENDENT CHILDREN WHO DO NOT LIVE WITH YOU
31A, NAME(S) OF ANY CHILD(REN) NOT 318. NAME AND ADDRESS OF 310 Mo aRioue ro YOU
IN YOUR CUSTODY PERSON HAVING CUSTODY CHILD'S SUPPORT
$
$

NSION (fiyou need additional space use Item 45 Remarks"). 5

NOTE: You do not have to submit medical evidence or list disabilities if you.are age 65 or older, unless you are housebound, or require
the regular assistance of another person.

32. WHAT DISABILITIES PREVENT YOU FROM WORKING? (List below) 33. DO YOU NEED THE REGULAR ASSISTANCE OF ANOTHER PERSON OR ARE
YOU GENERALLY CONFINED TO YOUR IMMEDIATE PREMISES?

Oves (2)Nno
NURSING HOME INFORMATION

NOTE: You may submit a statement by an official of the nursing home that tells us that you are a patient in the nursing home because of a physical or
mental disability. The statement should include the monthly charge you are paying out-of-pocket for your care.

344. ARE YOU NOW IN A NURSING HOME? ‘34B. NAME AND COMPLETE MAILING ADDRESS OF THE FACILITY 34C. HAVE YOU APPLIED FOR
MEDICAID?
Of "YES, "complete
Dyes [Jno Hiems 34B thru 34D) . (yes [xo
40. DOES MEDICAID COVER ALL OR PART OF YOUR NURSING. [34E. ARE YOU RECEIVING SUPPLEMENTAL SOCIAL SECURITY INCOME (SS)
ME COSTS OR HAVE YOU APPLIED AND NOT OR HAVE YOU APPLIED FOR SSI BUT NO DECISION HAS BEEN MADE?
RECENED A DECISION?

(ves [no [_JarPLIED-NOT RECEIVED DECISION | []Yes [_]NO q APPLIED - NOT RECEIVED DECISION

i YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM INITEMS 42A THRU 42C ON PAGE 10.
PAGE 7

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State, Counsel for Offenders

Texas Department of Criminal Justice
P.O. Box 4005
- Huntsville, TX 77342-4005
(936) 437-5203

May 12, 2015
Joseph Ceaser
- TDCI ID# 1944045
Estelle Unit (E2/032)
Dear Mr. Ceaser:
We recently received your letter asking for assistance with sex registration: The Zable of

Contents in Chapter 8 in Volume 1 of the State Counsel for Offenders Legal Handbook contains
general information.

Since sex registration is a paroie (and iree worid jegal issue), you must obtain the assistance of
an outside attorney that practices in this area of law. You can find addresses in the Texas Legal
Directory (Blue Books).

Both the Legal Handbook and the Blue Books are in the unit law library. The law librarian can
assist you in finding the information referenced herein.

Law office of Qonatd Hew ec.
AIM Wiest Som Rav bucw
Bun ham Ze TSyHis

Legal Services Danoce ace PRoged Fav Feee Lesatte
U. oF Texas Laws School
JLO/jv 727 LAST ZOOM St
Austin Te W210
cc: File _ i}



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P.O: Box IZ30K CaPinL Station 4-28
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Peaponse Back _ Wank Yow,

State of TR Tetras DeP2 ermat of Ceiminral Sustia,

¥ q Cad Livinsten
Mee Sik v, eas “e Executive Ditectod
Huntsville tx 17320-3320 Dis chaese Date Oct 23. ook
Peb 3. 2015 Ph 36-437 2101-437. 2/27

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ON Oct 23. 1198 Vou Pla SUsIty to the Offerse Ass éeutel SevusL NESUdIAiCause he-
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Rustin Te TS 74 Webs ite Te Coutr—Gov ¢ca

RE: CEa@sE@ Josert Drikoy ASex.
CCA, No Were HE IGS 30
Veise Cuwer Case No 191419

State Law Libsaw Tamer Cory Seontus
P.O. Box 12367. NSency

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1 . og . OMB Control No. 2900-0001 *
Respondent Burden: | hour
Expiration Date: 8/31/2017

VAY Department of Veterans Affairs VETERAN'S APPLICATION FOR COMPENSATION AND/OR PENSION

IMPORTANT - Read information and instructions carefully before completing the form. Type, print or write plainly {D0 NOT WRITE IN THIS SPACE)
— : (VA DATE STAMP)
1 FOR WHAT BENEFIT ARE. YOU! APPLYING?
([] compensation [7] PENSION [7] BOTH COMPENSATION AND PENSION
2. HAVE YOU PREVIOUSLY APPLIED FOR ANY VA BENEFIT(S)? (Check applicable box)
[] Pension [_] compensation [“] OTHER (Specify)
3. FIRST, MIDDLE, LAST NAME OF VETERAN
4A. VETERAN'S SOCIAL SECURITY NO. | 48. VAFILE NUMBER (/fapplicabie) | 4C, SPOUSE’S SOCIAL SECURITY NO.
40. IF YOU SERVED UNDER ANOTHER NAME, GIVE NAME AND PERIOD DURING WHICH YOU;SERVED AND SERVICE NO. .
5. MAILING ADDRESS (Number and street or rural route, city or PO., State and ZIP Code} : . z
6. TELEPHONE NUMBER(S) finchude At Area Code) 7.E-MAILADDRESS (If applicable)
DAYTIME B. EVENING C. CELL
8A. DATE OF BIRTH (Month, day, year) ~ 8B. PLACE OF BIRTH 9. SEX
’ , . (F mate [(] Femace
0A. HAVE YOU EVER FILED A CLAIM FOR COMPENSATION FROM | 10B. WHEN WAS THE CLAIM FILED? | 10C. FOR WHAT DISABILITY ARE YOU
THE OFFICE OF WORKERS’ COMPENSATION PROGRAMS? (Mo, day. yr) "RECEIVING BENEFITS?
(armerly the U.S. Bureau of Employees Compensation) “ Pa
O Yes ["] NO” (if "Yes." complete Items 10B & 10C) .

EET

SERVICE: RELATED \TED DISABILITY(IES) Ofyou fyi

11, PLEASE PROVIDE NATURE, OF SICKNESS, DISEASE, OR INJURIES FOR WHICH THIS CLAIM IS MADE; DATE EACH BEGAN; AND PLAGE OF TREATMENT

A. LIST DISABILITY(IES) B. DATE BEGAN C. PLACE OF TREATMENT
12A. ARE YOU NOW OR HAVE YOU RECEIVED 128. DATES OF TREATMENTICARE 12. NAME. AND ADDRESS OF VA MEDICAL FACILITY
TREATMENT OR DOMICILIARY CARE.AT A VA ‘Month Day Year (if you need more space use lem 45, “Remarks")
MEDICAL FACILITY?
(1 ves [J no Uy"Yes."complete Items 12B & 12C)

3A, HAVE YOU EVER BEEN A PRISONER OF WAR? 138. NAME OF COUNTRY 13C. DATES OF CONFINEMENT
Cy ves 2) No aprves.m FROM TO
AF "Yes, "complete hems 13B and 13) . 8

14, ARE YOU CLAIMING A DISABILITY RELATED TO AGENT ORANGE OR 15, ARE YOU CLAIMING A DISABILITY RELATED TO ASBESTOS

OTHER HERBICIDE EXPOSURE? (If "Yes," list disability(ies) below) EXPOSURE? (if "Yes," list disability(ies) below)
(J Yes [] no (ves [] xo
16, ARE YOU CLAIMING A DISABILITY RELATED TO MUSTARD GAS EXPOSURE? | 17. ARE YOU CLAIMING A DISABILITY RELATED TO IONIZING RADIATION

(Uf "Yes," list disabitityfies) below) . EXPOSURE? (If''Yes," list disability(ies) below)
(J yes (J no (J ves. [] no _ eee ee

18. ARE YOU CLAIMING A DISABILITY RELATED TO AN ENVIRONMENTAL HAZARD EXPOSURE DURING THE GULF WAR? (If “Yes, "list disability(ies) below)

CO yes (J no

* YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.

VA FORM SUPERSEDES VA FORM 21-526, JUN 2014,
Nov2014 21-526 WHICH WILL NOT BE USED. PAGES



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SERVICE INFORMATION

‘NOTE: Please complete the information for each period oF active duty. Attach DD214 or other separation papers for all periods of active duty. If you do not have
your DD214 form or other separation papers, check the box,

419A, ENTERED INTO SERVICE 198. SERVICE 19C. SEPARATED FROM SERVICE | 19D.BRANCHOF | 19E, GRADE, RANK OR
NUMBER SERVICE RATING, ORGANIZATION

DATE PLACE DATE PLACE

FORMATION

abies Cab

ate

NOTE: Enter complete information for each period of Reserves and National Guard service. Attach any separation papers you have.
20A. ENTERED INTO SERVICE 208. SERVICE 20C. SEPARATED FROM SERVICE am Sanne 208. GRADE, RANK OR
NUMBER ese" | RATING, ORGANIZATION
DATE PLACE DATE PLACE National Guard)
21. IF DISABILITY OCCURRED DURING ACTIVE OR INACTIVE 2A, ARE YOU NOWA MEMBER OF THE RESERVES | 228. RESERVE STATUS
DUTY FOR TRAINING, GIVE BRANCH OF SERVICE AND DATE OR NATIONAL GUARD? IF SO, GIVE THE BRANCH] () active [7] RESERVE
OF OCCURRENCE OF SERVICE OBLIGATION
. (ves ([] no BRANCH (Dy inactive

22C. NAME, ADDRESS AND PHONE NO. OF RESERVE OR NATIONAL GUARD UNIT (/fadidivional space is needed, use ltem.45 "Remarks")

Y RETIREDISEVERANCE E
IMPORTANT - Unless you check the box in Item 25 below, you are telling us that you are choosing to receive VA compensation instead of military retired pay, if
it is determined you are entitled to both benefits. if'you are ‘awarded military retired pay prior to compensation, we will reduce your retired pay by the amount of any
compensation ‘that you are awarded. VA will notify the Military Retired Pay Center of all benefit changes. If you receive both military retired pay and VA
compensation, some of the amount you receive may be recouped by VA. or, in the case of Voluntary Separation Iiicentive (VSI), by the Department of Defense.

3A, ARE YOU RECEIVING MILITARY] 238. WILL YOU RECEIVE MILITARY RETIRED PAY IN THE 23C. BRANCH OF 23D, MONTHLY
RETIRED PAY? (If "Yes," complete FUTURE? (If "Yes," explain, i.e. Future Reserve/National Guard . SERVICE AMOUNT
lems 23C & 23D) Retirement, Pending MEB/PEB)
Cl yes (] no (5 yes, [no ” $
24. RETIRED STATUS 25. NO, DO NOT WANT VA COMPENSATION IN LIEU OF MILITARY RETIRED PAY
Oo RETIRED. oO TEMPORARY DISABILITY oO DISABLED. (Check box. if applicable) oOo
RETIRED LIST RETIRED LIST
*26. HAVE YOU EVER APPLIED FOR OR RECEIVED DISABILITY SEVERANCE/SEPARATION PAY, OR ANY OTHER LUMP SUM PAYMENT FROM THE ARMED:
FORCES? (if “Yes, "list type, amount, date it was received, and the branch of service below)

(J ves [] no
= aE TaN OE: Z ne
Vi [MARITAL AND DEPENDENCY:INI TT oe

ir eboeens means OOM
278, SPOUSES'S BIRTHOATE (i, da. yr.)

27K. MARITAL STATUS (if married complete Items 278 thru 291)
(JJ married [[] wioowep [] Divorced © [_] NEVER MARRIED (ifnever married, skip to Item 30)

27C. NUMBER OF TIMES 270. NUMBER OF TIMES YOUR | 27E. IS YOUR SPOUSE ALSO A VETERAN? 27F, SPOUSE'S VA FILE NUMBER (ifany)
YOU HAVE BEEN PRESENT SPOUSE HAS
MARRIED (To include BEEN MARRIED (To Co ves [no Af "ves."complete
current marriage) include current marriage) tem 27F)
: c.
27H. REASON FOR SEPARATION (For example, 271, PRESENT ADDRESS OF SPOUSE

27G. DO YOU LIVE TOGETHER?

GI ves ([] NO Uf'No."comptete ems 27H thru 27) |

marital problems, job requirements, health, ete.) he

275, AMOUNT YOU CONTRIBUTE TO YOUR | 27K, HOW WERE YOU MARRIED?
‘SPOUSE'S MONTHLY SUPPORT [DJ CLERGYMAN OR AUTHORIZED [] TRIBAL [7] OTHER (Explain)
PUBLIC OFFICIAL
$ (J common-taw (J proxy

YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.

PAGE 6