Larson, Paul Allen, WR-20,644-09

Larson, Paul Allen

WR-20,644-09

| Tex. | Apr 1, 2015

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Case Information

*1 WR No. 20,644-_·_

Ex parte In the Texas Court

Paul Larson Criminal Appeals

RECEI.YED IN cause Nos. 449008-C, 44900,8-D, 465007-C, & 465007-D .COURftW~'R1MfM<~CAPPEALS WR 20,644-04, WR 20,644-05, WR 20,644-06, WR 20,644-07, & WR 20644-08 · APR 012015

PETITION FOR WRIT OF ERROR/BILL OF REVIEW

COMES NOW, Paui Larson, Petitioner (hereafter Larson),· britg~~1,~?§~~·t~~~rk Honorable Court Larson's Petition for Writ Of Error/ Bill Of Review; and, in support thereof, will show:

JURISDICTION

A Bill of Review is a:

"[p]roceeding in equity brought for purpose of reversing or correcting prior judgment of ... court after judgment has become final. Rogers v. Searle, Tex.Civ.App., 533 S.W.2d 433, 437. It is in the nature of a writ of error. A "bill of review," or a bill in the nature of a bill of review, are of three classes; those for error appearing on the face of the record, those for newly discovered evidence, and those "for fraud impeaching the original transaction. Such bills are peculiar to courts of equity." Black's Law Dictionary, Fifth Edition, page 151

Larson brings this Action based on "error appearing on the face of the record" and/or "for fraud impeaching the original transaction." If the entire record of Cause Numbers 449008-C, 449008-D , 465007-C, and 465007-D had been brought before this Honorable Court {due to the restraints on Larson's abilities to copy and/or purchase copies of the District Clerk's files, Larson has no knowledge of what records were forwarded to this Honorable Court), then the fact a subsequent Court Order filed with this Honorable Court from the 263rd District Court, after Larson filed for Mandamus Action, neither referred to nor negated an earlier Order in these Causes which stipulated that there were unresolved issues which were to be decided by the Court, requiring further Findings of Facts and Conclusions of Law (copies attached), then error does appear on the face of the record. However, if, in fact, this allegation (of Fact) is not evident from the face of the Records received from the Harris County District Clerk's Office in these Cause Numbers, the extrinsic fraud has been perpetrated upon the Petitioner and this Honorable court "impeaching the original transaction," i.e., the denial of Larson's Application For Writ Of Habeas Corpus and/or Writ Of Mandamus.

The State perpetrated further Fraud upon the Petitioner and this Honorable Court by falsely designating the June 12, 2014 Answer "Original," and intentionally mailing Larson's copy to the wrong address, delaying delivery for a month.

PRAYER FOR RELIEF Larson PRAYS this Honorable Court GRANT Larson's Bill Of Review, Review the entire Habeas Record, Ordering-if necessary-the Harris County District Clerk's Office to provide both the Honorable Court and the Petitioner the Complete Habeas Corpus Files in the above and Foregoing Trial Court Cause Numbers and, thereafter, GRANTING the Relief origingally PRAYED for in Larson's Applications For Writ Of Habeas Corpus; for thus Doth Petitioner PRAY.

CERTIFICATE OF SERVICE Service has been accomplished by mailing a true and correct copy of the foregoing instrument (Bill of Review) to the following address: Honorable Linda Garcia, Assistant District Attorney; 1201 Franklin St., suite 600; Houston, Texas @ 77002, on this, the t2~ day of ('()~ 2015.

Signed On This The #-day of {~ ~'} , 201S.

UL LARSON, Petitioner ProSe 9 Bucan Street, #I Houston, Texas 77076-2451 SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned Notary Public, on this ~of R;b~ ,

My Commission Expires: *

---- 1 "t(A(C ....j- ~

NOTARY PUBLIC *3 Petitioner/ ~ / In the (check one): - \ .--fAuL A-t-t.AN ~SotJ 0 lili8t1ic+Court of~ Ml.N bC... kPMLS Plaintiff (Court Number) 0 County Court at Law -;:::----:--;-:--;--,- ----------~--------~--~--- 0 Justice of the Peace Respondent/ County, Texas Defendant (County)

Affidavit of lndigency

(Request to Not Pay Court Fees) Use this form to ask the court not to You must either 1) sign this form in You can be prosecuted if you lie on this form. charge you for court fees. This form is front of a notary public or 2) sign this form and sign and attach a completed also called an "Affidavit of Inability to The court may or may not approve this "Unsworn Declaration" form. By Pay Court Costs" or a "Pauper's Oath." request to not pay court fees. The court You can only use this form if: (1) you signing in front of a· notary, you swear may order you to answer questions get public benefits because you are under oath that the information about your finances at a hearing. At poor or (2) you can't pay court fees. provided is true and correct. By that hearing you will have to present signing and attaching an "Unsworn The information you give on this form evidence to the judge of your income must be current, complete, true and Declaration" form, you declare under and expenses to prove that you have no correct. penalty of perjury that the information ability to pay court fees. provided is true and correct. <D The person who signed this affidavit appeared, in person, before me, the undersigned notary, and stated J'

under oath:

"My name is :A-ILS-~

"My mailing address is

"My email address is

Check ALL boxes that apply and fill in the blanks describing the amounts and sources of your income.

® "I receive these public benefits/government entitlements that are based on indigency:

D SSI 0 WIC ~ Food Stamps/SNAP D TANF D Medicaid D CHIP D AABD D Needs-based VA PenSion D County Assistance, County Health Care, or General Assistance (GA) 0 LIS in Medicare ("Extra Help") 0 Community Care via DADS D Low-Income Energy Assistance D Emergency Assistance 0 Child Care Assistance under Child. Care and Dev~ment Blo5t Grant 5 • S. fJ • /2e:n Rr:.t'\ ~tJ I -- t:5e.t..J E-F I I ..SO 0 Public Housing Other: (Describe) If you receive any of the above public benefits, attach proof and label it "Exhibit: Proof of Public Benefits" ® "My income sources are stated below. (Check all that apply)

0 Unemployed since: (date) ----------------------------- -or- 0 Wages: I work as a for --------------;-;Yo,--u-r-,-jo-:-b-;tt:;-;.tle___________ Your employer 0 Child/spousal support D My spouse's income or income from another member of my household (if available} D Tips, bonuses D Military Housing 0 Worker's Comp 0 Disability 0 Unemployment ~ocial Security D Retirement/Pension 0 Dividends, interest, royalties 0 2nd job or other income: , · (describe) ® "My income amounts are stated below. $ t3t:4 G~ (a) My monthly net income after taxes are taken out is: Total income after taxes --+ liDo.£_ + $ {b) The amount I receive each month in public benefits is: Total amount received --+ (c) The amount of income from other people in my household is:* + "-$ _ _,tzfo=..-_ Total amount received--+ + ":--$ ____,...,~<---- (d) The amount I receive each month from other sources is: Total amount received--+ = $ rs2.~~ (e) My TOTAL monthly income is Add all sources of income above-+ *List this income only if other members contribute to your household income. Page 1 of 2 © TexaslawHelp.org- Affidavit of lndigency, February 2014 *4 ® About my dependents: 'The people who depend on me financially are listed below: Relationship to Me Na7 Age

1 l~b JJE. 2 -------------------------------------------------------------------------- 3 -------------------------------------------------------------------------- 4 -------------------------------------------------------------------------- 5 ------------------------------------------------------------~-------------- ® "My property includes: Value* CV"My monthly expenses are: Amount $ fs()o ~ Ltno . $ 4SeE Cash Rent/house payments/maintenance 'Z.Dote MD Bank accounts, other financial assets (List) Food and household supplies $ t../ z.. ~ fY'{c). {!.ij-prsFL- ~~. $ ~ Utilities and telephone $ Clothing and laundry $ Z.S'~ /VIo $ $ ~0~ $ Medical and dental expenses Vehicles (cars, boats) (List make and year) Insurance {life, health, auto, etc) $ $ School and child care $ Vehicle payments $ $ $ :s?J ~ 'f#o· Gas, bus fare, auto repair $ Child I spousal support $ Real estate (house or land) (Do not list the house you live in.) Wages withheld by court order $ $ Debt payments $ ~~ $ Other expenses (Describe) $ Other property {like jewelry, stocks, etc.) (Describe) $ $ $ $ $ Total value of property ~ I= $ l \ D ~ Total monthly Expenses ~ I._=--'-$ ________ _, *The value is the amount the item would sell for less the amount you still owe on it (if anything). ® "My debts include: List debt and amount owed. ~~il ~s; 3oo ~ /Mo #

To list any other facts you want. the court to know, such as unusual medical expenses, family emergencies, etc., attach another page to this form and label it "Exhibit: Additional Supporting Facts." Check here if you attach another page.O ® "I am unable to pay court costs. I verify that the statements made in this affidavit are true and correct." ®Your Signature. You must either: 1) sign this form in front of a notary public or

2) si is for ,and sign and attach a completed "Unsworn Declaration" form. I ~ Date State ofTexas 1-tC. ."> D 'S U(<...... ~ \.; . County of

Print the name of county where this Affidavit is notarized. ;;?-. .... J_S-CS , by Sworn to a~ed before me today, I; ¥"1 ~ Date Pri t name of person who is signing this Affidavit. ·- N~S~:;> NOT the notary's name. Page 2 of2 © TexaslawHelp.org- Affidavit of lndigency, February 2014 *5 .·.

WR No. 20,644-__

Ex parte In the Texas Court

Paul Larson Criminal Appeals Cause Nos. 449008-C, 449008-D, 465007-C, & 465007-D Austin, Texas WR 20,644-04, WR 20,644-05, WR 20,644-06, WR 20,644-07, & WR 20644-08

PETITION FOR WRIT OF ERROR/BILL OF REVIEW COMES NOW, Paul Larson, Petitioner (hereafter Larson), bringing before this Honorable Court Larson's Petition for Writ Of Error/" Bill Of Review; and, in support thereof, will show:

JURISDICTION

A Bill of Review is a:

"[p]roceeding in equity b~ought for purpose of reversing or correcting prior judgment of ... court after judgment has become final. Rogers v. Searle, Tex.Civ.App., 533 S.W.2d 433, 437. It is in the nature of a writ of error. A "bill of review," or a bill in the nature of a bill of review, are of three classes; those for error appearing on the face of the record, those for newly discovered evidence, and those "for fraud impeaching the original transaction. Such bills are peculiar to courts of equity." Black's Law Dictionary, Fifth Edition, page 151

Larson brings this Action based on "error appearing on the face of the record" and/or "for fraud impeaching the original transaction." If the entire record of Cause Numbers 449008-C, 449008-D , 465007-C, and 465007-D had been brought before this Honorable Court {due to the restraints on Larson's abilities to copy and/or purchase copies of the District Clerk's files, Larson has no· knowledge of what records were forwarded to this Honorable Court), then the fact a subsequent Court Order filed with this Honorable Court from the 263rd District Court, after Larson filed for Mandamus Action, neither referred to nor negated an earlier Order in these Causes which stipulated that there were unresolved issues which were to be decided by the Court, requiring further Findings of Facts and Conclusions of Law (copies attached), then error does appear on the face of the record. However, if, in fact, this allegation (of Fact) is not evident from the face of the Records received from the Harris County District Clerk's Office in these Cause Numbers, the extrinsic fraud has been perpetrated upon the Petitioner and this Honorable court "impeaching the original transaction," i.e., the denial of Larson's Application For Writ Of Habeas Corpus and/or Writ Of Mandamus.

Signed On This The JF" day of Fe-bwMt , 2015.

UL LARSON, Petitioner ProSe 9 Bucan Street, #I Houston, Texas 77076-2451 SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned Notary Public, on this ~of fd,~

My Commission Expires:

-::::::> * ---- ( &tf/--.(C ..._;2.. ~ NOTARY PUBLIC *7 (

EX PARTE

§ HARRIS COUNTY, TEXAS STATE'S·MOTION REQUESTING DESIGNATION OF ISSUES The State of Texas, by and through its Assistant District Attorney for Harris County, requests that this Court, pursuant to TEX. CODE CRIM. PROC. art. 11.07, §3(d), designate that the following issues need to be resolved in the instant proceeding: whether the applicant is being illegally denied credit for time spent on supervised release and whether the parole board has unlawfully revoked his supervised release.

Service has been accomplished by mailing a true and correct copy of the foregoing instrument to the following address:

Paul Allan Larson

9 Bucan Street #1

Houston, Texas 77076-2451

SIGNED this lth day of August, 2013.

Respectfully submitted,.

Linda Garcia Assistant District Attorney Harris County, Texas 1201 Franklin, Suite 600 Houston, Texas 77002 (713) 755-6657 (713) 755-5809 (fax) Texas Bar I.D. #00787163 *8 Cause No. 465007-C JN THE ?.63RD DTSTPJCT COURT

BY,: PAF.TE §

.l-' ALJL Ai..LAi'l: LARSON, HARRIS COUNTY, TEXAS § Applicant·

...... -· ,. STATE'S PROPOSED ORDER DESIGNATING ISSUES -,~:~.~ .......

Having reviewed the applicant's petition for writ of habeas corpus, the Cou..-1 finds that ...... ,, . .... .,, . ': the following issues need to be resolved in the instant proceeding: whether the applicant is being • ...... I illegally confined pursuant to a parole warrant and whether the parole board ha~ unlawfully imposed conditions on his mandatory release.

Therefore, pursuant to Article 11.07, §3(d), this Court will resolve the above~cited issue and then enter findings of fact.

The Clerk of the Court is ORDERED NOT to transmit at this time any documents in the above-styled case to the Court of Criminal Appeals until further order by this Court.

B:Y the follt>wing signature, the Court ad.opts the State;s Propo3ed OrutrDt:Signai.i.ug lssu~. flf1 1 8 z.m2 '", __ uv _____ - - : - - - - ' .ii.J1.i.

SIGNED on the.....:.-- day ot_

PRE'1 :.~G~GE . ' FILED' Chrltl· 02:r.lc!

District Clerk OCT 0 9 20_\Z ::=~~~{7 r-.,. li ... ll. or"

' . >4:. :~ :::--:l

Ji' l 'ir Ch :~ ~"'])

D r,s () .· '"tr/q <Jniet ·

~- ... ~··. . 4/JG .· . Ct?r;c Cause No. 449008-D ? 12 <OtJ

. . .. <

EX PAR~/~~~.;;;0'~~· :.:::> IN THE 263R 0 DISTRICT COURT

§ ·-. .... § OF

PAUL ALLAN LARSON,

Applicant HARRIS COlJNTY, TEXAS §

STATE'S PROPOSED ORDER DESIGNATING ISSUES

Having reviewed the applicant's petition for writ of habeas corpus, the Court finds that the toliowing issues need to be resolved in the instant proceeding: whether the applicant is being illegally denied credit for time spent on supervised release and whether the parole board has unlawfully revoked his supervised release.

Thetefore, pursuant to Article 11.07, §3(d), this Court will resolve the above-cited issue and then enter findings of fact.

The Clerk of the Court is ORDERED NOT to transmit at this time any documents in lhe above-styled case to the Court of Criminal Appeals until further order by this Court.

By the following signature, the Court adopts the State's·Proposed Order Designating Issues . . 4{ff6 : 4 'MM~

SIGNED on the ___ day of · ..4.111.__;_1\l ___ , 2013- *10 . ,. Cause No. 449008~C >· IN THE 263Rf) DISTRICT COURT

EX PARTE § §- OF

PAUL ALLAN LARSON, HARRIS COUNTY, TEXAS §

Applicant STATE'S PROPOSED ORDER DESIGNATING ISSUES IUtving reviewed the applicant's petition for writ of hab'eas corpus, the Court flnds that ' the following issues need to be resolved in the instant proceeding: whether the applicant is being

illegally ~Jonfined pursuant to a parole warrant and whether the parole board has unlawfully imposed <tJnditions on his mandatory release.

THerefore, pursuant to Article I I .07, §3(d), this Court will resolve the above-cited issue and then anter findings of fact.

Th~ Clerk of the Court is ORDERED to transmit at this time any documents in the above-stylbd case to the Court of Criminal Appeals until further order by this Court.

By the following signature, the Court adopts the State's Proposed Order Designating Issues. ocr 1 s

SIGNED on th e_ day of . __ ,2012. · --- ,rr-Jrr.;r;;T-:.7UU7\Hl.YJ_ .. _______________ ··----------- ----···· --- Texas Bar I. D. #00787163 *11 NOTICE: THIS FORM CONTAINS SENSITIVE DATA. Cause Number: ~ f; - '2. /o Lf ~ -

(The Cle~Toffice will fill in the catse Number when you file this form.) In the (check one): Petitioner/ r - } / _ \ -fA.uL A-Lt.'AN D liili8t1ict-Court of ~Ml.t-l'f')L iJPPMLS l,....ri-iSDiJ Plaintiff (Court Number) 0 County Court at Law ----------~~----~~~~~- D Justice of the Peace Respondent/ County, Texas Defendant (County)

Affidavit of lndigency

(Request to Not Pay Court Fees) Use this form to ask the court not to You must either 1) sign this form in You can be prosecuted if you lie on charge you for court fees. This form is front of a notary public or 2) sign this this form.

also called an "Affidavit of Inability to form and sign and attach a completed The court may or may not approve this Pay Court Costs" or a "Pauper's Oath." "Unsworn Declaration" form. By request to not pay court fees. The court You can only use this form if: (1) you signing in front of a notary, you swear may order you to answer questions get public benefits because you are under oath that the information about your finances at a hearing. At poor or (2) you can't pay court fees. provided is true and correct. By that hearing you will have to present The information you give on this form signing and attaching an "Unsworn evidence to the judge of your income Declaration" form, you declare under must be current, complete, true and and expenses to prove that you have no penalty of perjury that the information correct. ability to pay court fees. provided is true and correct. CD The person who signed this affidavit appeared, in person, before me, the undersigned notary, and stated under oath: \ f)-lL$-'b,..j

"My name is

"My mailing address is

"My email address is

"I am above the age of eighteen (18) years, and I am fully competent to make this affidavit. I am unable to pay court costs. The nature and amount of my income, resources, debts, and expenses are described in this form. Check ALL boxes that apply and fill in the blanks describing the amounts and sources of your income. "I receive these public benefits/government entitlements that are based on indigency:

D SSI D WIC D Needs-based VA Pension D County Assistance, County Health Care, or General Assistance (GA) 12(1 Food Stamps/SNAP D TANF D Medicaid D CHIP D AABD D LIS in Medicare ("Extra Help") D Community Care via DADS D Low-Income Energy Assistance D Emergency Assistance D Child Care Assistance under Child~ Care and Dev~ment Bloc,.k Grant s. s. fJ. /2e:rJR.E:.t'\liltJ r ....-t:ie.AJEF I T.S D Public Housing ~Other: (Describe)

If you receive any of the above public benefits, attach proof and label it "Exhibit: Proof of Public Benefits" ® "My income sources are stated below. (Check all that apply)

D Unemployed since: (date) --------------------------------- -or- D Wages: I work as a for Your job title Your employer D Child/spousal support D My spouse's income or income from another member of my household (if available) D Tips, bonuses.[:JMilitary: t-lq~sing .. D yvorker's Comp D Disability D Unemployment ~ocial Security D Retirem~rlt!Pensioii ~ .[)i~i_?~rids: intere~t. royalties D 2"d job or other income: --------~;---";;--;-------- . (describe) .. ® "My.inC<brrie arrto.ur:l~S~~ai"i~ .~!~tecf 6~19w::~' $ l3til ~ . ''(~);My:~fnoritllly:n-~1"i~;td~·g,~(t~;~t~}~;;·af~;·;~~en out is: Total income after taxes~ ·.I~ 0 ~ (b) The a~d~i{pf ·~e~~~v~:;·~~~h ~o-~t-h 'j~-~~b·i;~ benefits is: Total amount received~ + $ ' :(c) The.~mbun(6f,jQ¢9r;li~;f~Oiii.:ot.h~'~··aeopf~'Jn my household is:* Total amount received ~ + "'$ __ ____.~=--

(d) The '~inoJnt'l fe~~i~~'+e~th~~b~·ffi· f~8h~\).ther sources is: Total amount received ~ + '=$ __ -J*'d'~=-= Addallsourcesofincomeabove~ = $ 132.~~ (e) tVi'tr6{A.~c;;·~?!Jthiy'iQcbrri~·[§ '" .,., . .-:;·

*List this inr;:ome only ilother members contribute to your household income. Page 1 of 2 © TexaslawHelp.org- Affidavit of lndigency, February 2014 *12 I-·,,

® About my dependents: "The people who depend on me financially are listed below: Relationship to Me ~ry A~ /~b we..

1 2

3 4 ----------------------------------------------------------------------------- 5 ----------------------------------------------------------------------------- 6 -------------------------------------------------------------------------- ® "My property includes: Value* CV"My monthly expenses are: Amount $ 4 $ e:>_9 $ ~D~ lfrlO · Cash Rent/house payments/maintenance 'ZL>ote /MD Bank accounts, other financial assets (List) Food and household supplies $ 'I z.. ~ pYle) • {}.. H-i>cs Fv ~ ~ $ ~ . Utilities and telephone $ Clothing and laundry $ z_$~ frtO $ $ ~e~ $ Medical and dental expenses Vehicles (cars, boats) (List make and year) Insurance (life, health, auto, etc) $ School and child care $ $ Vehicle payments $ $ Gas, bus fare, auto repair $ S?J~fntJ· $ Child I spousal support $ Real estate (house or land) (Do not list the house you live in.) Wages withheld by court order $ Debt payments $ ~~ $ $ Other expenses (Describe) $ Other property (like jewelry, stocks, etc.) (Describe) $ $ $ $ $ Total value of property ~ I= $ l \ D C3'- Total monthly Expenses ~ L l =___,$ ________ _ *The value is the amount the item would sell for less the amount you still owe on it (if anything). ® "My debts include: List debt and amount owed. ~~il ~$ 3cD ~ /tvlo ~

To list any other facts you want the court to know, such as unusual medical expenses, family emergencies, etc., attach another page to this form and label it "Exhibit: Additional Supporting Facts." Check here if you attach another page. 0 ® "I am unable to pay court costs. I verify that the statements made in this affidavit are true and correct." ®Your Signature. You must either: 1) sign this form in front of a notary public or

2) si is for and sign and attach a completed "Unsworn Declaration" form.

~ 6~~~~~~~

Date Notary fills out this section !! ~ou-. =- _ ·:.. ___ . _ -, State ofT exas ~ .) f) ' <' tt! li'\~'V: '"r.l"!:l'-"~~~N · ,,,~~~~~~z,,, are signing in front of a notary!! I ~o~~·· ··.<l-'~ o a!"Y, stern~ nere: {;c,(C.........'f-......\.-:> . County of §"( ';'<'§ mary PubliC, State of Texa J Print the name of county where this Affidavit is notarized. ';~·r%·~$-~:: My C~ommisst.J'or Expires ~ ... /f' Of\<i-,,~ No" r 20 I Sworn to a~ed before me today, ;;?-.-..I.._S-(5 I_---.::.,!!"''::__ - : J~ 1h.: t: ' ' ' 'by -=---·"'"'---=-c..--.··- Pri t name of person who is signing this Affidavit. ~~~~ Date N~~::> NOT the notary's name. Page 2 of2 © TexaslawHelp.org- Affidavit of lndigency, February 2014 *13 BNC#: 14Blll5D44177 Over..,. .. ·.-----~-------4

/-·------.- .. :--·--·- ~-------------~ SOCl-\L SECTJRlTY ADMINlSTRA TION FIRST-CLASS MAIL PRESORTED GREATLAKES PROGRAM SERVICE CENTER . POSTAGE AND FEES PAID POBOX 8Cl8 SOCIAL SECURITY ADMINISTRATION CHICAGO 1L 6068.0-8018 PERMIT NO. G·11 OFFICIAL BUSINESS P~NALTY FOR PRIWITE USE. $300

P AllL A LARSON PO BOX 524001 HOUSTON TX 77052~4001

R - Op~n a my Social Security account ut1 iuiiii'IIIIIUitl•llultJJIIIhiJ( nhsiiiJII•i•IJu ,,hUI s

ScciaiSecurity.gov

UFTTO OPEN '

Your New Ben.efi.i Amou:nt 86E9657 . /OtJCJS$~ IS"/~

BENEFICIARY'S NA.MK PAUL A LARSON 'rbur Social Security benefits will increase by l. 7 perct;,nt in 20 15 becm ~se of a rise in the cost of living. You c~m. m;~ this ictt~:r wh~n you nceri proof of youl' h-cntHt tunouni: to receive t'ood, rent:, or eiM~rgy a~f.sistanr:r.; t::1tnk loans; or ib;" other bui~il!cs~. Keep this letter with your impmtant financial records .

.Ho~_l\iln..:.h ·wm.I_Get AD C. \\'het!7..

• Your monthly amount (befon:! deductwns) is

• The amount we deduct for Med.lcare medical insuran~c is

- -- (Ifyo1.idid.ricifliave}ifedicafe-as ofNov. 20,2014,

or if ~x~:Ii\;';(j!J.(~ c·l.[c ~·:tys your premium, we show $(1.00.)

• The amount 'Ne deduct for your Medicare pr~scription drug plan is $0.00.

(If you did not elect withholding as ofNov. 1~ 2014, we show $0.00.)

• The amount we deduct for voluntary Federal tax withholding is $0.00.

(lf you did not elect voluntary tax withholding as of

Nov. 20,2014, we show $0.00.) " After we take any other deductions~ you will receive $1,309.00

on or about Jan. 2, 2015. lfyou disagree with any of these amounts~ you must write to us within 60 days trom the date you receive this letter. \Ve would be happy to review the amounts.

You may receive your benefits through direct deposit, a Direct Express® can~ or an Electronic Transfer Account. If you still receiv~ a paper check and want to switch to an electronic payment, please visit the Department of the Treasury~ Go Direct website at www.godirect.org .

. What lf I Have Questions'?

Please vi..r.;it our website at www.sociulsecurity.gov tor more information and a variety of online serviC{$. You also can calll-800-772-1213 and speak to a representative from 7 a.m. unti17 p.m., Monday through Friday. Recorded information and services are available :24 hours a day. Our lines are bu.-.iest early in the week, early· in tht: month, as well ~~s during the week between Christmas and New -- ··· Year's Day; it is best to call at other times. If you are deaf or hard of hearing~ call our TrY number, 1-8()0..325-0778.lfyou are out<;;ide the lJnited States, you can oontact any US. embassy or con.sulate office .. Please have your Scx~iai Security claim number available when you call or visit al'ld include it on any letter you send to Social Security. If you are inside the United States and need assistance of any kind, you can visit your local office.

89&9 LAKES AT 610 DR HOVSTON TX

·' *15 . . ., . ~ HAST..CLASS MAIL c PRESORTED SOCIAL SECURiTY ADMINiSTRATION POSTAGE AND FEES PAID M05 C:~REAT LAKES PROGRAM SERVICE C.E:l\:TER SOCIAL SECURITY 1 ADMINIST~ATION 600 WEST MADISON ST PERMIT NO.Q .. f1 CHICAGO IL 60661·2474 OFFICiAL BUSINESS

PENALTY FOA·PRiVATE USc, $.300

PAUL A LARSON

PO BOX 524.00 l

HOUSTON 'l'X 77052-4001

u!IUI II lie !r lllulh '''hI! 111111 ^[1] 1 h ul ,, hll'•ai!•IIJ ^[11] ! ^[11] 111 II ·.•

I!J

Open a my Social Security account

. Snr.ialS.ecuribJ . .aoy ___________________ ~---------

FORM SSA-1099- SOCIAL SECURITY BENEFIT STATEMENT l 2014 • PART OF YOUR SOCIAL SECURiTY BENEFiTS SHOWN IN BOX 5 MAY BE TAXABLE iNCOME. ' -~ !

! • sEE THE REVERSE FOR MORE INFORMATION. ^[1] e ~x 1. Name i6ox 2. Benefic:ary's Social Security Numbe~J§ i! I . 386-40-3920 \ PAUL A LARSON E 1---- I ! Bo~ 4. 8el1efliSRep-aldto ssAir, 201-4- j Box 3. Benefits Paid in 2014 Boxs: N~t~$ncf.lts 9[.?'0:1~:(BC>K.~:'ilif1us~"'4) ::: i ·_ ~ $t5;~#0.QO. $16.620.00 $700.00 . __ _ _ _. ~-------- oEscRIPTtoN oF AMouNTfN eox 3 · - - r - - · - - - oescRtPrt~N ~~AMouNT rN aox d $15.920.00 I Deductions for work or other ! Paid by check or direct deposit

Deductions for work or other ~-tdjustnlfmts i Benefit.-; repaid to 2014 SSA in $700.00 adjustments ^[1] $700.00 $7Q0.QQ I Total Additions flil6.620.0tl 1 I i Benefits for 2014 $113 6')0 00 · '" I I I I

L ____ _ i ^[1] I r-·-----·------ I Box •3. Vo;untary Federal Income Tax Withheld \1 NONE ~ I I 1 Box 7. Address I ! }'AULA LAltSOl'~

I I I PO BOX 524001 I HOUSTON TX 77052-4001 I I I h I~ l ~ 8-;;;~~ C:iai~• Number (t.Jse :."'is number if yov need to contact SSA) - I 1.:. i 386-40-3~}20A ·_j'~ I . ~------------- ~ . · 099 SM (·,··:; 0 - 15 !~--·--~------,- 00 ij(;fili'i'iJR~VHis'F-oRMTO s~ 0~ lAS, . . . .. ---~·-.•. orm F SSA -l • ''- . . ,. . . . . ......... .