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U mr JR US JBCQUELINE P GLOSSQ
QfflE FILED 08/28/2014
JAMES W. MYART. JR. IN THE DISTRICT COURT
PLAINTIFF, BEXAR, COUNTY
V.
JACQUELINE GLOSSON AND STATC OF TEXAS'
EWtN NORMAN GLOSSON, DEFENDANTS ,
IN THE DISTRICT COURT OF BEXAR, COUNTY STATE OF TEXAS, JAMES W. MYART, JR., Petitioner and
JACQUELINE GLOSSON AND CW1N NORMAN GLOSSON, DEFENDANTS .
PAUPER'S AFFIDAVIT IN REQUE5TTHAT FILING AND OTHER FEES BE WAIVED
Personally appeared before the undersigned officer, duly authorized by law to administer oaths in the
State ol TEXAS, JAMES W. MYART, JR., Petitioner in the above styled cose and on oath stales that: =
I am the Petitioner in the above styled case and that owing to my poverty 1 am unable to pay any costs ■
n the foregoing matter. My monthly income is S741.00 and I pay S938.00 per month rent tent and)
iving expensed.
This Affidavit represent myaexpenses«aQgJ5Jncorporated
anses^Qgjsj herein as if fully set torch verbatim.-^- ^7
— jr.--.- -
co ■--r
KOfllNAZAHORA
l MY COMMISSION EXPIRES
SOCIAL SECURITY ADMINISTRATION
Date: July 28, 2014
Claim Number: XXX-XX-9315A
XXX-XX-9315DI
JAMES W MYART J
323 PRESTON AVE
SAN ANTONIO TX 78210-2315
You asked us for information from your record. The information that you
requested is shown below. If you want anyone else to have this information, you
may send them this letter.
Information About Supplemental Security Income Payments
. Beginning August 2014, the current
. Supplemental Security Income payment is § 721.00
This payment amount may change from month to month if income or
living situation changes.
Supplemental Security Income Payments are paid the month they are due. (For
example, Supplemental Security Income Payments for March are paid in March.)
IP YOU HAVE ANY QUESTIONS
We invite you to visit our web site at www.socialsecurity.gov on the Internet
to find general information about Social Security. If you have any specific
questions, you may call us toll-free at 1-800-772-1213, or call your local
office at 866-964-7432. We can answer most questions over the phone. If you are
deaf or hard of hearing, you may call our TTY. number, .1-800-325-0778. You can
also write or visit any Social Security office. The office that serves your
area is located at:
SOCIAL SECURITY
3438 E SOUTHCROSS
SAN ANTONIO, TX 78223
DOCUMENT SCANNED AS FILED
If you do call or visit an office, please have this letter with you. It will
helD lis answer your Questions. Also, if you plan to visit an office, you may
call ahead to make an appointment. This will help us serve you more quickly
when you arrive at the office.
OFFICE MANAGER
\'«
Supplemental Security Income
Notice
From: Social Security Administration
Date: JUL2120H
Claim Number: xxx-xx-9315
James Willie Myart Jr.
323 Preston Ave.
San Antonio, TX 78210
You must meet certain medical and nonmedical requirements to be entitled to disability
benefits: ""- •• - ' •• ,..._ ... .. .. _
We have found that you meet the medical requirements for disability benefits. An
explanation of our findings follows. Please read it carefully.
We used the following report(s) in deciding your claim:
Shannon Kelly. Consultative Examination, report received, 06/17/2014
The Center for Health Care, reports received, 05/22/2014
Leo K. Edwards Jr., reports received, 05/21/2014
Southeast Baptist Hospital, reports received, 05/13/2014
You said that you became unable to work on August 21, 2010 because of bipolar, high
blood pressure, and diabetes.
While you stopped work because of your condition, the medical evidence did not show
your condition was severe enough to meet our requirements until your hospitalization
on April 16. 2014. Because of the severity of your condition at that time and medical
experience with your type of condition, your impairment(s) met our requirements! as
early as April 16, 2014.
We have not yet made a decision about whether you meet the nonmedical
requirements, but we will make that decision soon. Then we will send you a second
notice explaining our decision. AFTER YOU RECEIVE THIS SECOND NOTICE, YOU
WILL HAVE 60 DAYS TO APPEAL THE DETERMINATION WE MADE ABOUT YOUR
CLAIM FOR DISABILITY BENEFITS.
IF YOU HAVE ANY QUESTIONS ABOUT YOUR DISABILITY CLAIM OR WISH TO
APPEAL OUR FINDINGS, PLEASE DO NOT GET IN TOUCH WITH THE SOCIAL
SECURITY OFFICE UNTIL YOU HAVE THE SECOND NOTICE. The people atthe
Social Security office will be better able to answer your questions when they have the
DOCUMENT SCANNED AS FILED
.information from both notices. You can look us up online at www.ssa.gov. call our
national 1-800 number at 1-800-772-1213.
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can
find you a lawyer or give you free legal services if you qualify. There are also lawyers
who do not charge unless you win your appeal. Your local Social Security office has a
list of groups that can help you with your appeal.
If you get someone to help you, you should let us Know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
After you have received your second notice, you can call or write any Social Security
office to appeal our determination or to get answers to your questions. Most questions
can be handled by telephone or mail. If you go to the Social Security office in person,
please take both notices with you.
Social Security Administration
SSA-L1157-SI
DOCUMENT SCANNED AS FILED
Civil Action File No.
ORDER OF THE COURT
JAMES W. MYART, JR. IN THE DISTRICT COURT
PLAINTIFF, BEXAR, COUNTY
V.
JACQUELINE GLOSSON AND STATE OF TEXAS
EWIN NORMAN GLOSSON, DEFENDANTS .
This Court, having considered the Petitioner's request to proceed in forma pauperis, hereby grants the
request.
This .day of.
Judge, DISTRICT COURT
BEXAR COUNTY, TEXAS
DOCUMENT SCANNED AS FILED