Ceaser, Joseph Rickey ( 2015 )

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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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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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NO l``E: Please complete the information for each period ofactive duty Attach DD2l4 or other separation papers for all periods ol``active duty lfyou do not have
your DD2l4 form or other separation papers check the box |:\
19A: ENTEl?;ED lNTO SERV|CE 195. SERV|CE 19C. SEPARATED FROM SERV|CE ~ i 19D. BRANCH OF 19E. GRADE, RANK OR
`` NUMBER SERV|CE . RATlNG, ORGANlZAT|ON
DATE PLACE DATE ' PLACE
NOTE: Enter complete information for each period of Reserves and National Guard service Attach any separation papers you have.-
20A. ENTERED 1Nr0 sEvacE _ 205. sEercE zoc_ sEPARArED Fr=_zorvr sEvaeE S::';b:ET€Y'_?F' zoE. GRADE, RANK on
`` , NuMBER `` _ (_""“ RAT|NG, oRGAleATlON
DATE PLACE `` DATE PLACE N“"“"“' "”"/}
_/’ "_ "_" .
21 rF DrsAeiLiTY occuRRED DuRiNG AcrivE oR 1NAcT1vE 22A ARE You Novv A MEMBER oF THE RESERVES 223 RESERVE STATUS
ourv FoR rRAerNG GrvE BRANCH oF sERvicE AND DATE on NATroNAL GUARD? rF so erer _THE BRANCH l:| ACT,VE l:| RESERVE
oF occuRRENcE 01= sERvicE _ ostreAnoN
t [:| _YES |:] NO BRANCH [| inAcrl\/_E
22C. NAME, ADDRESS AND PHONE NO_. OF RESERVE OR NAT|QNAL GUARD UN|T (I_/``au'dilir)na/ space i.\' needed, u.vu llem``,45 "Remark.s"')
lMPORTANT » 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 benei'rts. ll you are awarded military retired pay prior to eompensation, we will reduce yo'u``r retired pay by the amount of any
compensation'that you are awarded VA will,notify the Military Retired Pay Center of all benefit changes lf you receive both military retired pay and VA
compensation, some ot" the amount you receive may be recouped by VA`` or, in the case of Voluntary Separation l``ricentive (VSI), by the Depanment of_Defense.
23A. ARE YOU RECE|V|NG MiLlTARY 23B. W|LL YOU RECEi\/E MILITARY RET|RED PAY lN THE 230- BRANCH OF 230. MONTHLY
RET|RED PAY? (lf "Yes, "complele FUTURE? ([f ")'es, "éxp/ain, i.e, Fu_ture Reserve/National Guard - SERV|CE AMOQNT
ltems 23C & 23D) Retiremenl, }’ending MEB/PEB) '
g YEs l:l No ij YEs_ [:l No $
241 RET|RED STATUS 25. NO, l DO NOT WANT VA COMPENSAT|ON lN LlEU OF M|L|TARY RET|RED PAY'
l:l RETrRED m TEMPORARY DlsABlLiTY [:] DlsABLED (Check box.'ifapplicable) l:]
RETIRED LlST RET|RED LlST
'26 HAVE YOU EVER APPL|ED FOR OR RECE|VED DlSABlL|TY SEVERANCE/SEPARAT|ON PAY OR AN_Y OTHE_R LUMF SUM PAY|V|ENT FROM THE ARMED
FORCES? (l_/ "YL'\. "ll\'l type alm)rurl dale il \111.\' rcc¢.'i\ezl. mull/w branch uf .\cri ice hc/r)\r')
|:| YEs m No-
27A MAR|TAL STATUS (l_/ married c()/np/ele ]Ienl.\' 2 7/1‘ lhru 29/))
. 27a sPouSES'S BlRTHDATE (M11.. 11¢1,11._111.)
E] MARR|ED [:] WlDoWED l:| DlvO_RcED ' |:] NEVER MARRiED(//111»11)11111111111/, 1111/1111/1€11131)) " '-
27€1. NUMBER OF T|_MES 27D~ NUMBER OF T"V|ES YOUR 27E. IS,¥OUR SPOUSE ALSO A VETERAN? '27F. SPOUSE'S VA F|LE NUMBER (Ifany)
YOU HAVE BEEN PRESENT SPOUSE H.AS ' - . `` -
MARRlED (l``u include ..BEEN MARR!ED (7``0 l:' YES l: NO (lf"Yes, "comp/ete '. '
CW"¢" ”'””"”XL’) include current marriage) l - ' '[lem 2 7}")
. _ ~ " C-
27G. DO YOU LlVE TOGETHER? 27H. REASON FOR SEPARATION (l"r)r example``, __ - 27|y PRESENT ADDRE$S OF SpOUSE
' niarila/ proh/cm.\'.jr)b ruqr/il'uniul1l.r, hea/Ih, elc``,) ' ,)_.
|:’ YES |:} NO (lf "No, "comp/ele llems_27H thru 27./) w
27.1. AMOUNT ¥OU CONTR\BUTE TO YOUR 271< HOW WERE YOU MARR;ED')
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