LAW OFFICE OF

MATTHEW L BONEY

SOCIAL SECURITY DISABILITY CLAIM FILING

Claimant Name

E-mail

Social Security Number

Phone Number

Mailing Address

Have you filed a claim for SSA benefits in the past?

If yes, approximate date of filing?

Are you currently working?

What type of Disability do you have? Check all that apply.

Physical

Mental

Blind

Deaf

Mutism

Optional Message to Accredited Attorney Representative

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Disclaimer: Nothing provided in this website should be considered legal advice or legal opinion. This web site is not intended to create an attorney-client relationship or otherwise open a file. Please contact one of our attorneys to schedule an office conference for personal and confidential advice concerning your legal matter. The choice of a lawyer is an important decision and should not be based solely upon advertisements. Licensed in the following jurisdictions: Federal Eastern District of Missouri, United States Tax Court, Immigration Court, the U.S. 4th Circuit Court of Appeals which encompasses North Carolina, Maryland, South Carolina, Virgina and West Virginia; and the 11th Circuit Court of Appeals which encompasses Florida, Georgia and Alabama. Matthew Boney generally does not practice issues of NC law nor is he licensed by the NC Bar. However, he may accept cases concerning issues of NC law via pro hac vice which requires acknowledgement by the NC Bar. Should you have questions in regards to North Carolina law you should consult an NC licensed attorney. You may call the NC Bar referral service at (919) 677- 8574.

Any reliance on the information contained in this correspondence by someone who has not entered into a fee agreement with THE LAW FIRM OF MATTHEW BONEY is taken at the reader’s own risk.

MATTHEW L. BONEY & ASSOCIATES

POST OFFICE BOX 70184

MYRTLE BEACH, SOUTH CAROLINA 29572