Court Opinion

ID: 4050508
Source: CourtListenerOpinion
Date Created: 2016-09-29 01:16:32.392192+00
Date Added: 2024-06-11T12:44:57.046049
License: Public Domain

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’ 1 ’ . 5 ‘ OMB Comro| No_ 2900-0001 ‘1
' Respondem Burden: l hour
Expiration Dare: 8/31/2017

VETERAN'S APPL|CAT|CSN FOR COMPENSAT|O_N AND/OR PENS|ON

 

   

 

100 NoT leTE m THls sPA¢E)
1vA DATE sTAMP)

 

 

1. FOR WHAT BENEF_lT ARE You APPLY|NG? 4
§- coMPENSAT»loN § PENsloN § BOTH co_MPéNSATlON AND PENSloN

 

2 HAVE YOU PREV|OUSLY APPLIED FOR ANV VA BENEF|T(S) ? (( /mkapplicab/e hu.x)

§ PENSloN § coMPENSATloN § oTHER(Specify)

 

 

3. F|R’STl M|DDLE, LAST NAME OF VETERAN

w .n._

4A. VETERAN'S SOC|AL SECUR!TY NO. 4B. VA F|LE NUMBER ([/`a/)p/i¢~ab/e) 4C. SPOUSE'S SOC\AL SECUR|TY NO.`

 

 

 

 

4D. lF YOU SERVE_D U[\JD§R ANOTHER NAME, G|VE NAME AND PER|OD DUR|NG WHlCH YOU.»SERVED A`ND SERV|CE NO.

 

 

5. MA|L|NG ADDRESS (N11111/1e1' and .\‘Ireel ar rural rr)u/¢.'. c/'Iy ur l’.()., Slale and le’ ('.'r)de)

 

6 TELEPHONE NUMBER(S) (lnc/udu Area(_. ade) 7-.‘E-MA\_LADDRESS_(l/`£lpp/ic‘ab/€)
A. DAYT|ME B EVEN|NG C CELL

 

 

 

 

aA. DATE OF BlRTH 11140,111,, day year/ eB. PLACE oF BlRTH .' 9. sE><
4 1 , - . 1 `. § MALE § FEMALE

10A' HAVE YOU EVER F|LED A CLA!M FOR COMPENSAT|ON FROM 1OB. WHEN WAS THE CLA|M F|LED? 1OC. EOR WHAT DlSAB|LlTY ARE YOU
THE oFFlcE oF WORKERS' coMPENsAT10N PROGRAMS? W”~ d”y- .v'-/ ' _RECE'V'NG BENEF'TS?
(l"r)rmer/y /lw l/..S`. Bureau Qf`l;'n_1[)l0yee.\' Compenmlion) _ . af

§ YES {:] NO' a (If "Yes. " cbn1}1/ete ltems ]0B & /()C)

 

 

 

 

 

 

 

11 PLEASE PROV‘DE NATURE OF SICKNESS. D|SEASE OR |NJUR|ES FOR WH|CH TH|S CLA|M lS MADE; DATE i:ACH BEGAN; AND PLACE OF TREATN|ENT

 

 

 

 

 

 

 

 

 

 

 

 

 

A. LIST DlSABlLlTY(lES) ` B. DATE BEGAN C. PLACE OF TREATMENT
* 12A ARE You NOW oR HAVE You REcE\vED -` 123 DATES oF TREATMENT/cARE 120. NAME.AND ADDRESS 0F vA MED|CAL FAC|L|TY
TREATMENT OR DOM|C|LIARY CARE AT A VA . 1 ' (]fy()u need more .\'pace use llem 45, "l\’emark.\")
MEDacAL FAclL\TY? M°""' Day' _ Ye~a' ‘
§ YEs` § No (1f"Yes,"comp/e1e lzem; 1213 &12C)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13A'. HAVE YOU EVER BEEN A PR|SONE_ER OF WAR? - 135. NAME QF COUNTRY ' ' 13C, DATE_S OF CONF|NEMENT 1
w - "" ` FRoM . _ 10
[:] YES m NO (l/ Ye.\' comp/ere /Iem.\' I.JB ami l3() . 4 ` n _ 14 ~ 0
14 ARE YOU CLA\M|NG A D|SAB|L|TY RELATED TO AGENT ORANGE OR ' _` _ 15. ARE YOU CLA|MlNG A DlSABlLlT_Y RELATED TO ASBESTOS
OTHER HERB|C|DE EXPOSURE'? (l_/ "Ye.\,"/1\(di.\11/)iliL\1(ic.s) helrm) ' l EXPOSURE? (I_/ "Ye.\'. "11\1 disabllily(ies) be/ou)
§YES§NO ` "§YES§NO
16 ARE YOU CLA|M|NG A DiSAB|L|TY RELATED TO MUSTARD GAS EXFOSURE? 17. ARE YOU CLA|M|NG A D|SAB|L|TY RELATED TO |ON|Z|NG RAD|AT|ON
(l_/ "Yc.\ "liv/ dl.\ab/I/`/y(iu\) hclm¢) EXPOSURE'? (l/"YL'A',"/i.vldi.vabiliL\/(ie.§) hel¢)w)
§YES§NO ._ _ §YE_s'§ No __ ,__.,., w .
18. ARE YOU CLA|M\NG A D|SAB|L\TY RELATED TO AN ENVIRONMENTAL HAZARD EXPOSURE DUR|NG THE GULF WAR? (If'"Yc.\', " /1'.\'1 di.\'abili/y(ies) bela\v)
§ YEs § No
‘ YOU MUST SlGN AND PR|NT YOUR NAME AND DATE TH|S FORM lN lTEMS 42A THRU 420 ON PAGE 10.
VA FORM SUPERSEDES VA FORM 21-526, JUN 2014.
Nov 2014 21'526

WH|CH W|LL NOT BE USED. PAGE 5

 

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YOU MUST S|GN AND PRINT YOUR NAME AND DATE TH|S FORM |N-lTEMS_ 42A THRU 420 ON PAGE 10.

 

PAGE 7

 

State Counsel for Offenders

Texas Depart_ment of Criminal Justice
P O. Box 4005
- Huntsvi||e,TX 77342-4005
' (936) 437-5203

May12,2_015

lJoseph Ceaser
TDCJ ID#. 19_4.4()45
Estelle Unit (E2/032)

Dear Mr. Ceaser:

We recently received your letter asking for assistance with sex registration; The ]'" able of
Contents in Chapter 8 in Volurne 1 of the State Counsel for Offenders Legal Handbook contains
general information

Since sex registration is a paiole (and 11 ec World legal issue), you must obtain the assistance ot
an outside attorney that practices in this area of law You can find addresses 1n 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.

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