SPACER
LOS SANTOS SOCIAL SECURITY ADMINISTRATION
DISABILITY BENEFITS APPLICATION
SPACER
- APPLICANT INFORMATION
Full name: William Stavola
Age: 59
Address: 123 Glazier Street, Los Santos, San Andreas
Phone no.: 9894
SPACER
DISABILITY INFORMATION
Primary disability: Blindness/Visual Impairment
Description of disability:- William Stavola is legally and visually blind due to advanced retinitis pigmentosa, diagnosed in 2017. This condition has resulted in near-total vision loss, severely limiting his ability to perform daily tasks such as reading, navigating public spaces, or operating machinery. He relies on assistive devices like a cane and screen-reading software, and requires assistance for mobility and business management.
Supporting medical documentation:- Medical records from Los Santos Independent Blindness Facility, ophthalmologist report by Dr. Maria Cortez.
EMPLOYMENT AND FINANCIAL INFORMATION
Current employment status:- Self-employed, owner of Relaxing Hands Spa on Glazier Street, Los Santos. Due to blindness, William struggles to manage daily operations, reducing his active involvement to administrative oversight with assistive technology.
- Manager at Relaxing Hands Spa, impacting job performance.
- Limited income from Relaxing Hands Spa (approx. $1,200/month after expenses), no other benefits or pensions.
DECLARATION AND ACKNOWLEDGEMENT
I, William Stavola, declare under penalty of perjury under the laws of Los Santos and the State of San Andreas that the above information is true and correct to the best of my knowledge. I certify that the disability described prevents me from engaging in substantial gainful activity and meets the eligibility criteria for disability benefits as outlined by the Los Santos Social Security Administration. I understand that providing false information may result in denial of benefits, fines, or other legal consequences under the laws of San Andreas.
I acknowledge that the Los Santos Social Security Administration may require additional documentation or medical evaluations to verify my disability. I agree to cooperate fully with any requests for further information or examinations to process this application.
Applicant signature: ⠺⠊⠇⠇⠊⠁⠍ ⠎⠞⠁⠧⠕⠇⠁
Date: July 23, 2025