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DEP TIVIENT 11F THE ARMY 782, LIUTARY POLICE DETACHISSIT (CID) (PlYD)
34 MILITARY POLICE GROUP (CID) UNITED STATES ARMY CRIMINAL INVESTIGATION COMMAND
EAGKDAD, E AE 69=
CIMPR-FR 24 Sep 04
MEMORANDUM FOR SEE DISTRIBUTION
SUBJECT; CID REPORT OF INVESTIGATION FINAL (C) / SSI 0249-04-CID259-80283 /5C1/5Y2E
DATES/TIMES/LOCATIONS OF OCCURRENCES: 1. 16 JUL 0410001 HRS 17 JUL 04/ 2400; UNKNOWN LOCATION NEAR TAJI,
IZ.
DATE/TIME REPORTED: 02 AUG 2004, 0900 HRS
INVESTIGATED BY: SA SA b76 -6htiiz
t -li 2
SUBJECT: 1. (UNKNOWN); (NFI) [CRUELTY AND MALTREATMENT (UNFOUNDED)] [AGGRAVATED ASSAULT (UNFOUNDED)]
b 7 t VICTIM: 1. 111.11111111111111. CI CAPTURE: 17 JUL 04; (NF1) [CRUELTY AND LTREATME UNFO [AGGRAVATED ASSAULT (UNFOUNDED)]
74-9, 414147 2. CIV M; DATE OF
CAPTURE: 17 JUL 04; A (WI) [CRUELTY AND MALTREATMENT (UNFOUNDED)] [AGGRAVATED ASSAULT (UNFOUNDED)] 4,74 -4, 2--
INVESTIGATIVE SUMMARY:
On 02 Aug 04, this office received a Memorandum of Transmittal (MOD (0266-04-CID899) from the 22nd Military Police Battalion (CID), Camp Cooke, Tali Iraq (IZ) wherein MINIM 67 el. 6- Y
11111111111111111111111.11 (NFI) related two unknown Iraqi National Guard (ING) Soldiers 1.3 7Z-1644 -4/ and two unknown U.S. Soldiers, in separate instances, had physically abused him.
01111n1111111111111=11111111 (NFI) reported he had been physically abused by the ING and b7c- ,044 -V not U.S. Soldiers.
Investigation established no credible evidence existed to substantiate Mr1.1.111 and Mr 1)1L -SidAd - V alliclaims of aggravated assault and cruelty and maltreatment. Therefore, the listed /,7c -'bb/ -V
offenses were unfounded. Further investigation determined the injuries sustained by Mr 11111110and ad been the results from Mrellineand IVIM1111110scape attempts hic-i
FOR OFFICIAL USE ONLY LAW ENFORCEUENT SENSITIVE
, 1.
M; DATE OF 13)] b7t-Y./.4 - 41f/P
DODDOACID-004625 ACLU-RDI 87 p.1
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0249-04-C102.59.80283
and capjuLe by the ING. U.S. Forces were not involved in the apprehension of MilliliPt7r.44)a.i/ and DAW
STATUTES:
Article 128, UCMJ: Aggravated Assault (Unfounded) Pada D3, UMW: Cruelty end Maittestment (Unfounded)
EXHIBITS/SUBSTANTIATION:
Attached:
1. Agent's Investigation Report. AIR of MOT, the interview of 2L
,
SJA coordination. 161-i/
23 Sep 04, detailing the receipt of the e trite eve of 201111111.11 records query, and
Ale-'i APE/
2. AIR of SA 23 Jul 04, detailing the basis for investigation, the collection of digital photographs of the injuries to and Mrnnother interviews, the collection b7t-51.).6i -4/ of detainee packets the interview of S the interview of Millinlialthe Owl - / interview of SP the Interview L the interview of Mainland the interview of SG be-9,11(.9 pe:. 46,56-di
,rzythf -"V
3. Camp Cook Detention Center Detainee Information Log concerning Man= 17 Jul 04. lag
4. Camp Cook Detention Center Detainee Information Log concerning M17 17 Jul 04. -4/
5. Sworn Statement of SGTINIMINk 22 Jul 04, concerning his knowledge of the incident and the detainees condition upon arrival to the Brigade Interrogation Facility (SIP).
670,1 , 1 6. Sworn Arabic Statement of Mr11111111111Pand translation, 22 Jul 04, detailing his allegations of abuse.
b7e-016 -1 471-4/)/4-1/ 7. Sworn Statement of SPC11111111111111 22 Jul 04, concerning her observations of wiregkorior to his interrogation.
9. Sworn Statement of SP C11.111, 23 Jul 04, detailing her medical evaluation and treatment provided to the detainees.
10. Sworn Statement of 2L i , 6 Sep 04, pertaining to his knowledge of the alleged abuse.
hie-464-4/ 11. Sworn Statement of 2L1111111111 6 Sep 04, pertaining to his knowledge of the alleged abuse.
6TH-y)4.
411-'06-V 12. Document Packet containing the interrogation reports of WirlINIIMMand !An, classified as Secret.
FOR OFFICIAL USE ONLY LAW ENFORCE115IENT SENSITIVE
8. Sworn Statement of 1o
L7-r in"th 22 Jul 04, detailing his observations of the detainees when they arrived at the BIF.
Not Attached:
(.4
DODDOACID-004626 ACLU-RDI 87 p.2
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0249-04-CID259-80283
The original of exhibits 1,2, and 5 - 11 are forwarded with USACRC copy of this report. The
originals of exhibits 3-4 and 12 are maintained in the detainee files of the Detainee Operations,
National Forces Iraq (114NF-I) Baghdad, Iraq.
STATUS: This is Final (C) Report. This investigation was terminated in accordance with CDR 195-1, Chapter 4-97 (a)(4), wherein the office of the staff judge advocate is of the opinion that there is Insufficient admissible evidence aVallable to substantiate the offenses and that additional Investigation would produce only cumulative and urineeded evidence, and that the identlfieation of additional subjects or offenses Is unlikely. Leads remaining: Thel_rIteilliew of 1L.TNIIIIIIk-the interview of the ING SOICREMB that captured Mind Mind bre-3;
111),4-1, yV the ii-i of the victims. Commanders Report of Disciplinary Men Taken (DA Form 4833) Is not required.
Report Prepared By: Report Approved By:
Distribution:
1-DIR, USACRC, 6010, 6th Street, Fort Belvoir, VA 22060-5506 (original) 1-Thru: CDR, 22nd MP BN (CID) (FWD), APO AE 09342
Thru: CDR, 3" MP Group (CID) To: CDR, USACIDC, ATTN: CIOP-ZA, Fort Belvoir, VA 22060
1-PMO, INF-I (e-mail only) 1-CID LNO, MNF-I, APO AE 09335 (e-mail only) b7C-3.66 . .3 1-Office of the Staff Judge Advocate, Ill Corps, ATTN: CP11111111(email only) 1-File
FOR OFFICIAL USE ONLY LAW ENFORcElifiENT SENSITIVE
DODDOACID-004627 ACLU-RDI 87 p.3
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4.111011.n111011111.1.
78 LIP DIM Forward (CID) Eagb.dad, Iraq APO AE 09342z,
Date: 23 Sep 04 Enhibit:
LA 3r SMISITIVE
Spa OA i Si
otea DA FOR. OFFICIIM USE ONLY -POR _ _ _
NJ
DODDOACID-004628
For Official Use Only Law Inform:neat Sensitive
2`.-10M1" S INVESTIOCIONT REPORT 0249-08-CID259-802 03
CX Regulation 1951
oe 3
Basis for Investigation: On 02 Aug 04, this office received a Memorandum of Transmittal (MOT) (000266 -04CID899) from the 22 nd Military Police W.talion, (CIO) Camp.Cooke, Taji Iraq (IZ) wheiein Mr
(NFI) related twob7c-44,14 -4 unknown Iraqi at ona %Jar NG) Soldiers and two unknown U.S. Soldiers, in se arate : inStances, had physically abused him.
Mr (NFI) reported he had been b7C - Y, hi - 4/
p ys ca y aused by t e . IN and related U.S. Soldiers had not abused him.
At 1705, 12 Aug 09 the undersigned interviewed 2LT 111111.11.107e-mi& - V
C Co, 3 - 153 INF BN, Fort Apache, IZ who/i7t.1/2b/ 4
related if the ING had been involved they would have brought the detainees to the gate and then the Officer-in-Charge (OIC) would have received the detainees for processing. 2LTIIIIMINIMPZ -11.,./Z -4/
related he could not recall any joint operations or raids where the ING were involved. 2LTWill. related he would behig.tif available for future interview and he would attempt to locate other soldiers that may have assisted him in the transfer of the detainees from the ING.
At 1144, 6 Sep 04, the undersigned interviewed 2LT /11111111111111110t*g.J 1V
who provided a sworn statement concerning the capture of Mr.1111.67&1466 -4/
and Mx 2LTENNIIIIII. related Mr OM and Mr0111111111es -t4vje06.tivy.,
were captured by the ING and transported to their unit for processing . 2L11111.111116 related the injuries to Mand 67.4 a/Ake& is Mr were sustained prior to arrival at their facility and
iv b 6-v incurred during their apprehension by the ING (See Sworn Statement of 2LT1111111111.b/e4i...a&V
At 1153, 6 Sep 04, the undersigned interviewed 2LT , C Co, 3- 153 INF BN, Fort Apache, i .whoOell.)46Y
prav, ded a sworn statement concerning the ..
captaiii Mr 1M and,67elf, f - 5%f
Mr 2LT elated Mr and Mr were , .. irtWhOsodg-&V,,,ft r
capture by thelleri transported to their unit for processing. 2LT related the injuries to MrilikandAX.V468..e , M were sus a ned prior to arrival at their facility and 676, v, p g1,6.v
d' incurre during their apprehension by the ING. 2LT 674- 44F66-9' related he had been informed by the ING that Mr nd Mr6x-0/04 -9
4111110had resisted capture and also had attempted escape while ye .y),46,9
c 4- a/
ACLU-RDI 87 p.4
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t.1
Date : 23 Sep 04 LAW ENFORCEIUNT SENSITIVE 704 orricIAL USE ONLY
Exhibit : Signature
CID PoramDA
For Official Umo Only Law Enforcement Senaitivc
AGENT'S INVESTIGATION REPORT 0249-04-CID259-00283
CID Regulation 195-1 Page 023
under the apprehension of the ING. 2LT le. observed the INGIgelidibti soldiers had bandages on their arms and heads from the in uries sustained during Mr and Mr capture. 2LT WWII 46'VASI related Mr and Mr- injur es had been assessed andkitoirithi,- 0144 treated by th company medics (See Sworn Statement of 2LT SIM /1Z4114"/ .
. .45 I
Agent's Comment: During the interview both 21T and 2LT - related a local Mosque had been broa casting,b0 01W 1
utilizing a public address system located within the Mosque, that if they (Iraqis) are detained to claim abuse in order to
= get released early. In addition they added that the word on the street is to get captured by the Americans, claim abuse and you will get three hot meals a day, air conditioning, fresh water and then be let loose to fight another day.
At 1730, 8 Sep 04, the undersigned and SA this office, conducted a Biometric Automated Tools Set (BATS) uer to obtain the Internment Serial Number (ISN) and locate Mr
and Mrtill.with negative results. ffribak itS6- 4 itit63 At 1520, 10 Se 04, the undersigned coordinated with CPT
, Office of the Staff Judge Advocate, Campb7,p.46-.5 Victory, IZ, who opined there was no credible evidence to substantiate MrIIIII1Wand Mr claim of aggravated assaultigg-W443 and cruelty and maltreatment.
At 1842, 14 Sep 04, the undersigned coordinated with 2LT 0111111110 who related a 15-6 investigation had been conductedb74.61.4G .61
concerning this incident by the 3-153 INF BN, Fort Apache, IZ. 2LT did not know the individual who conducted the67e4a4a 3 investigation and did not know where the final report of the 15- 6 investigation was located. 2LT related no guard4X1W-4, rosters were maintained and guard u y was rotated base upon who was available and not on missions; no list could be provided to this office.
Between 6 Sep 04 and 23 Sep 04, this office made several attempts throughout this investigation to locate a copy of a 15-6 investigation conducted by unknown elements of the 3-153 INF
ble-/) 660 SA Specia
7S NT DET Foxvar-d (CID) Agent, Baghdad, Iraq APO AE 09342
DODDOACID-004629 ACLU-RDI 87 p.5
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7S MP DET Forward (CID) Baghdad, Iraq APO AE 09342 Date: 23 Sep 04 Exhibit:
LAN ENFORC SEESITIVE I FOR orriciaL USE asix
For Official Us Only Lew Enforcement Sensitive
0289-04-C/D299-90283 &GMT'S MESTIGRTION REPORT
CIS elation 195-1
age 3 ag 3
BN, Fort Apache, which met with negative results. ///LAST ENTRY///
ti E:
DODDOACID-004630 ACLU-RDI 87 p.6
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06170i-oy-cio0757-6,2 83
Nw.......111
ROI AGENT'S INVESTIGATION REPO T CID 'levitation 1154
nn;.nnn.a.Pm.wnmil alIIII*IM18/:Mma,sa.*4w.n
PAGE. 1 OF 3 tAGES
DETAJLI
About 1500, 21 Jul 04, tins office received notification from the 301iritadeCOatbat Team (ECTYProvost Marshal Office (PMO), Camp coo* itaq APO AR 093/$8 -*AO identified lfrough Sum*, Intiraaptian Report (SIR) # 1CD-239-275044417:aird # 1CI37239-27544424, two detainees .fig bifida( the Brigade Intezrogation Facility (EN), Camp CoOke.;Taji, Iraq APO A/3093/8, claimed to have been beaten by Maisie:an soldiers Mid soldiers frotn the Iraqi National Guard prior to their arrival to the FITP. . .
saikaiimatius. bout 4000 22 Jul 04
A office, coordinated with 2LT
2X, 239 Milittay,Intelligence Company, Cano'Cooke, Taji, Iraq APO At 09',..3714.0. Aolki-provided digital images taken of th:o tWo detainee's injuries at the tune of theirenivel at
/ bout 1100, 22 Jul 04, SA id interviewed SG , OK:Mary Police (MP) Company; 004 Cooke, aiit hug APO. AB 0937 zee of the detainees froM the KV .to the Charlie Company Medical,. Facility (Chailie Med) Camp Cooke,
said he *as scram b SOT AE 0.9$1S. 1.0
fi 45 riiinuteii While ll*'recelifetirt i43,14 :63 445-17 'd the detainee appeared to have bath Anis/hes
detainenbnek to the B1F atthe674.43.4 3; .
GENT'S COMMENT: SOT ad: Prather investigation di
A* bout 1315, 22 Jul 04, SA coordinated with MSG 642nd
term= Company, Cinip tioke, ali,.1rari APO AE 09378, p related . . . . . . e ustod' " sent at the IMF when the two detainees were brought into .the facility on i/ Jul 04. MSG -
'd he noticed the detaineeshacl bruising to the fa; and appeared to . havobeen beaten. MSG kg*. b6 -3 d not have any further contact with the detainees. 6. 7 4. 3) ble3 . . . ..
A bout 1320, 22 Jul 04, S coordinated with SGT 642nd aintenance Company, Camp Cothke, Taji, Iraq APO AE 09378, who provided digital' images of the detainees d their injuries as well as all detention facility and medical documents pertaining to the two detainees. (See
ee intake padkets and medical documents for details) . 4) i .744,1464
bout 1330, 22 Jul 04, S ' terviewed SO 42nd aintenance Company, C tp. Coo e, Tajt, Iraq APO AE , w prow a sworn statement. SOT
lated his knowledge of the incident and he was the Sergeant of the Guard when the two detainees ble).$6.6a
dical treatment foeseV everely beaten. SG
nclusion of the media examination an 3,1
,APO AE 093/8 at appr4o1ditiatelY 1000,18 Jul 04. SO 9 .Copipany, Camp Cooke, Taji,
ated he and SG at Charlie MeMed.for rfaciarand torso 'es. SG
-3 could not recall which of the two d it was detainee
be transported to Charlie *410 i-
ere brought in to the INF. (See Swim Statement for Details) TYPED a r 9 , ER
14e-61 e h2_ ORGANIZATION 386 Militmy Police Detachment CID Comp Cooke, Taji, keg, APO AE 09378
FICIAL USE ONLY-LAW ENFORCE' SENSITIVE
ii V 7
DODDOACID-004631 ACLU-RDI 87 p.7
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PAGE 2 OF 3 PAGES
An Y, 66 -v breisvp6P6
g4666
(174fii-OY-C1D.26-,-8(P.83
ACENT INVESTIGATION' REPORT Craiterdatica 195-1
MAILS
..nFbout 1450, 22 Jul 04, S aji, Iraq APO AB 09378 tespreter American
Ti-lo 44.9 ktf interviewed Detainee BIF', Camp Co laze, vided a sworn statement, in Arabic and it was translated by CAT H Titan, Camp Cooke, Taji, Iraq APO AE 09378, detailing he was abused by
worn Statement for Details).
About 1500, 22 Jul 04, ' terviewed SPC Charlie Company Medical, 39th Support B on, Camp Cooke, Taji, Iraq APO AE 09378; Who prOVided a sworn statement detailing her examination of detainee lap on 21 Jul 04, before and after his interrogation at the MY. (See Sworn Statement for Details)
About 1510, 22 Jul o4, S terviewed PLT 1115 Transportation Company, 6 ,.. Cciokejaji, Iraq APO AB 378, WhaProvi.ded a in;vorn Statement detains his observations when the detainees were brought into the BIF. 1L1.1111111related he was the Officer in Charge (OIC) at the BIF at the time of intake of the detainees. (See Sworn Statement fbr Details)
-/ About 1650, 22 Jul 04, S mterviewed Mr IF, Camp Cooke, Taji, Iraq APO AE i' , with the assistance Mr lated he was lopoi hts-a, 7 apprehended by the Iraqi military and taken to a building where they him several titaelwith their fists and objects. He related he was then transported by a green in color car with ING on the side of it, to Adaymeia Palace, Baghdad, Iraq where Iraqi and U.S. Forces were stationed. He stated he was beaten by the Iraqi's several times while he was there. Mr re. load no U.S. soldiers struck or hit him at any dine and that the U.S. soldiers treated him very well. lated he saw the first Iraqi military building he was handcuffed to a chair beside him and they /13MIR hi . and telling them to admit to doing bad things and they would stop beating them. Mr ated he believed Mr lavo.,66..
111111111111was transported to the palace also but did not know what happened to him there.M.-4b6 -9 4 .
About 0920 23 Jul 04, S interviewed SGT " Charlie Company Medical, 39 Support Battalien, Cann; Cooke, Taji, Iraq APO AE 0 , w .. provided a sworn statement detailing her observations when the detainees were brought into the BIF. SW elated she was the on duty medic at the BIF and provided initial medical evaluations and treatment of e detainees. (See Sworn Statement for Details)
71f-tiA64-y
About 1030, 23 Jul 04, SA oilliallhiterviewed SG who said he accompanied SGT on 18 Jul 04, when they transported detainee om the BIF to Charlie Med and back. SGT
er related he observed numerous bruises on detainee and it appeared that the detainee had . SGT said the detainee was speaking in Arabic during the trip to Charlie Med and it
appeared that he was co p of pain to his various injuries. ORGANIZATION 313ft Military Police Detachment CID Camp Cooke, Tail, Iraq, APO AE 09378
SIGNA
CID FORM 94F L USE ONLY-LAW ENFORCEMENT SENSITIVE
TYPED AGENT'S NAME S SEQUEN NUMBER
4X-1 42-
8
DODDOACID-004632 ACLU-RDI 87 p.8
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AGENT'S INVESTIGATION :REPORT CID Replatkat 195-1
ROINUMBER 0226-04CH3399
PAGE 3 OF S PAGES DETAJLS
STATUS: No further investigative activity is anticipated. This case is closed in the files of this officeJ//LAST ENTRY///
'144)614,1, ORGANIZATION 38th Military Police Detachment CID Camp Cooke, Taji, Iraq, APO AE 09378
EXHIBIT DATE 23 Jul 04
E ONLY LAW ENFORCEMENT SENSITIVE
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DODDOACID-004633 ACLU-RDI 87 p.9
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U.S. CENTRAL 7115 S UTH AT CO-6- MACDILL AIR FO CE FLO DA 33621-5101 -
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MS. JACQUELINE SCOTT [email protected] (813) 827-5341/2830
ACLU-RDI 87 p.10
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Page(s)
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Referred to 110S0 \ I Y MEDICAL COMMAND 7REEI1OM OF INFORMATION/
P;11 1VACY AC? OFFICE A 3NTION: MCFP 2050 W01:7.11 LOAD, SIJIT.-1413 FORT SAM HOUSTON, TEXAS 78234-6013
MR, JOHN PE ERSON Johna?etersonl cen0ameddoarmyemil (2. 10) 221-7826
DODDOACID-004635 ACLU-RDI 87 p.11
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U.S. CENTRAL CO MA\ND 7115 S UTH BOUNDA'Y LV ATTN: C06-DM MACDILL AT FO CE ASE FLO IP)
D 3-3621-5101 -
MS. JACQUELINE SCOTT [email protected] (813) 827-5341/2830
ACLU-RDI 87 p.12
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Page(s)
Referred t U.S. A?P: MEDICA_, C MMAND FREE \OM OF INFO `AT ON/
PRIVACY ACT DEPICT AT ENT:ON: MCFP 2050 WO::TH ROAD, S J1 El 13 FORT SAM HOUSTON, TEXAS 78234-6013
MR. JOHN PETERSON John.Peterso 1 cen...amedd.armyomil (210) 221-7826
DODDOACID-004637 ACLU-RDI 87 p.13
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U.S. CENT L CO MAN 7115 SUTH BOUN BLV
ATTN: CCJ6- MACDILL FO CE ASE FLO " D '\ 13621-5101 -
MS. JACQUELINE SCOTT scottjfeenteom.smil.mil (813' 827-5341/2830
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, HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT E INS ON PAGE 1, AND S ON PAGE,.. --7-FFITILLY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT
MADE BY ME. THE STATEMENT IS TRUE. I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD WITHOUT THREAT OF PUNISHMENT. AND WITHOUT COERCION. UNLAWFUL INFLUENCE, OR UNLAWFUL INDUCEMENT
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For use of Ms form. see AR 190-45: the .roponeni agency is ODCSOPS PRIVACY ACT STATEMENT
AUTHORITY Too 10 USC ScteIVI 201 T.Ib 5 USC Sawn TM 1 0 MIR and IftyRost 2. 1313 MR) Mu/OPAL PURPOSE
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DA FORM 2823, DEC 1998
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SWORN STATEMENT ft/ used Ms form. um AN 1 1 5' isODCSOPS
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MADE BY ME THE STATEMENT IS TRUE. I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD. WITHOUT THREAT OF PUNISHMENT. AND WITHOUT COERCION. UNLAWFUL INFLUENCE. OR UNLAWFUL INDUCEMENT
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MADE BY ME THE STATEMENT IS TRUE. I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD
.
WITHOUT THREAT OF PUNISHMENT. AND WITHOUT COERCION. UNLAWFUL INFLUENCE. OR UNLAWFUL INDUCEMENT
re lemoilff:g14t*el WITNESS Summed me swore Is be
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DODDOACID-004647 ACLU-RDI 87 p.23
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, WANT TO MARE THE FOLLOWING STATEMENT UNDER OATH:
ReEPJAP
04-49 e71
CV1I% 0 -C 26-7- 80 2.83
LOCATION Camp Victory. Baandad. Iraa
DATE 6 SePr
"FILE NUMBER
3 - r3 1.4.# 414 r
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1 EXHIBIT INITIALS OF PING STATEMENT AK-e-,...0;41- OF S PAGES
t1 THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT AND BE 1 : AS "PAGE OF PAGES." WHEN ADDITIONAL PAGES ARE UTILIZED, THE SACK OF PAGE 1 WILL BE LINED OUT AND THE STATEMENT WILL BE CONCLUDED ON THE REVERSE SIDE OF ANOTHER COPY OF THIS FORM. i_____ DA FOR 2823. JUL 72 SUPERSEDED DA FORM 2823, 1 401,84MHI Gt1 WILL BE USED.
FOR orrx....e 05E __ LAW-NFORCE...',.:-LENT E7.15.T: / / 0
PAGE V 1 I ADDITIONAL PAGES MUST CONTAIN THE HEADING `STATEMENT' TAKEN AT DATED CONTINUED."
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DODDOACID-004648 ACLU-RDI 87 p.24
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PAGES.
FOR OFFIC1.1, USE CELY LAN ZNFORCEF:ENT SENSiTiVE
DODDOACID-004649
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ACLU-RDI 87 p.25
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Statement)
7 7 -US' - 4:- IL) A) 7 - bod-05
USE Op e r .er
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Subscribed and sworn to before me, a person authorized by Law to administer oaths, this ( day of 5e.p4ebv.bcA , 2004 at Camp Victory, Baghdad, Iraq
n_114011.1111111wea)114-/ (Typed Name of Person Administering Oath)
Article 136, UCMJ
11 11 WITNESSES:
AFFIDAVIT
1, HAVE READ OR HAD READ TO ME THIS STATEMENT WHICH BEGINS ON PAGE 1 AND ENDS
ON RSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE BY ME. THE STATEMENT IS TRUE. I
HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT. I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OR BENEFIT OR REWARD, WITHOUT THREAT OF PUNISHMENT, AND WITHOUT
. ..
COERCION, UNLAWFUL INFULENCE, OR UNLAWFUL INDUCEMENT.
ORGANIZATION OR ADDRESS
ORGANIZATION OR ADDRESS (Authority to Administer Oaths)
Pun r?" LAVi .
' INITIALS OF PERSON MAKING STATEMENT
U.S. Government P
PAGE 3 OF 3 PAGES 3427180494
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DODDOACID-004650 ACLU-RDI 87 p.26
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FI 11 oFrr.1.0. VdSE Cr". i VSMIEVAINE rr
For use of this form, see AR 190-45; the prep Urgency is ODCS (
Oe741 -0 Y MAI) 4-77 0 tAr-CL5
C4' 44"V 157.8141 DATE
640 TIME 40-00-
FILE NUMBER
IAL SECURITY NUMBER heePAPV
GRADE/STATUS 0 /
, WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:
umnoN Camp Victory. Baandad. Iraq
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ADDITIONAL PAGES MUST CONTAIN THE HEADING "ST OF TAKEN AT DATED CONTINUED." THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT AND BE INITIALED
AS 'PAGE OF PAGES." WHEN ADDITIONAL PAGES ARE UTILIZED, THE BACK OF PAGE 1 WILL BE LINED OUT AND THE STATEMENT WILL BE CONCLUDED ON THE REVERSE SIDE OF ANOTHER COPY OF THIS FORM.
DA FOIRSEM117=" --- SUPERSEDED DA FORM 2823,1 JAN 68, WHICH WILL BE USED.
F.F1 USE r. ' 7:11FLACE.'IENT
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DODDOACID-004651 ACLU-RDI 87 p.27
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DODDOACID-004652 ACLU-RDI 87 p.28
-
ORGANIZATION OR ADDRESS
Subscribed and sworn to before me, a person authorized by Law to administer oaths, this Jday of SecAeutpol , 2004 at Camp Victory, Baghdad, Iraq
,A-4.6 Oath)
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7 4 AFFIDAVIT HAVE READ OR HAD READ TO ME THIS STATEMENT WHICH BEGINS ON PAGE 1 AND ENDS
ON P TAND THE CONTENTS OF THE ENTIRE STATEMENT MADE BY ME. THE STATEMENT IS TRUE. I HAVE INITI ED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT. I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OR BENEFIT OR REWARD. WITHOUT THREAT OF PUNISHMENT, AND WITHOUT COERCION, UNLAWFUL INFULENCE. OR UNLAWFUL INDUCEMENT.
zjew.06 , Statement)
WITNESSES:
(Typed Name of Person Administering Oath) Article 136, UCMJ
ORGANIZATION OR ADDRESS (Authority to Administer Oaths)
INITIALS OF PERSON MAKING STATEMENT
DODDOACID-004653 ACLU-RDI 87 p.29
-
PAGE 1 of 1 PAGES
DETERMINE LOCTION OF DETANIEEs AND RE-INT TO CLARIFY WHAT AND HOW HE WAS BEATEN AND BY WHOM
0111111 77 Action
Photograph /Nngerprint subjects
NVESTIGATNE STANDAR.D.S Z . .. . :Nft M /141.e. , ..----1:., ' ; N.lititra.' svapeNeg_DEPOSITED.. r :
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10 day days RF.A.FOLLOW UP
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DODDOACID-004654 ACLU-RDI 87 p.30
-
AGENTSACTRiffialAARY (CID Regulndon 195-I)
Control Number 0249-04-C1D2S9-
SUMMARYOFINVEMATTVEAatIVITY
Basis for Investigation: On 02 Aug 04, this office received a Memorandum of Transmittal (MOT) (000266
-04 - CID899) from the 22" 1
Military Police Battalion (CID), Camp Cogice, .....Ta j 1 Iraq ( 1 z ) wherein Mr 11111111111.1111111111kos
(NFI) related two unknown Ireqiiim4 ational-
Guard(ING) Soldiers and two unknown U.S. Soldiers, in separate instances, .had hysically abused
grall"111111111.11 him. Mr- (NFI PIAM4Ake ,
reported- 'e had been physically abused by the ING and
related U.S. Soldiers had not abused him.
TIME, DATE, AND AGENT
0900,2 Aug 04 Agri)44-1
OD FORM 25 I Oct BO PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED
DODDOACID-004655 ACLU-RDI 87 p.31
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AGENTS ACTIVITY SUIRAARY (CID Regulation 195-I)
Control Number 0249-04-0D259-80283
TIME DATE, AND AGENT 0900 2 Aug 04
4V.A.66-/
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SUMMARY OF INVESTIGATIVE ACITIVITY Drafted INI and submitted for approval.
Received IM Updated USB Drive File.
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CID FORM HI I Oct BO PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED 3
DODDOACID-004656 ACLU-RDI 87 p.32
-
AGENTS ACTIVITY SUMS4ARY (CID Regulation 195-1)
Control Number 0249-04-C1D239-80283
DATE, AND AGENT SUMMARY OF INVESTIGATIVE ACITIVITY
t-73b %s(pol fimp
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Coordinated with LT ho related L
arrives back in 29th
and both would be available for interview upon his return. LT el t e N .CDR or XO would be accompanying them on the convoy here: 'LT related convoys to and from his area are
difficult to organize do to the =erg combat operations in the area. Olp c6-61 514 eepod 70 sue.
Ikimw..,118 E LTIONIMIR-Car INT el. OA Iva 01 09.0,
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CID FORM 25 I Oct SO PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED
u 4 3
DODDOACID-004657 ACLU-RDI 87 p.33
-
AGENTS ACTIVITY SIJ ARY CID Re Motion 195-I
Control Number
8IIMMAR1GE INVESTIGATIVE ACITIVIT'V Office of the Staff Judge Az* k.
IZ, who opined there was no credible evidence to and Mr11111110claim of aggravated assault and cruelty Forces.
TIME, DATE. AND AGENT Coordinated with CPT Advocate, Camp Viet substantiate and maltreatment U.
1?..eik56-qj
1520, 10 Sep 04 fig4.0 66-4
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Drc. era 5 r4-r- TO 34c I.
PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED U
0912/ 11 Sep 04 abox-0
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Updated SITREP. TO SAC.
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DODDOACID-004658 ACLU-RDI 87 p.34
-
14 Sep 04 bFe61.06I
1 30, 14 Sep 04 1111110 b X%46-
1842/ 14 Sep 04 II. 76 0 -/
1845/ 14 Sep 04 67e64L --/
1919/14 Sep 04 67e-',4d,
1920/14 Sep 04 111111A /I-44 6 /
AGENTS ACTIVITY SUMMARY (CID Regulndoa
Control Number 1169t-04ClD259-80285
TIME. DATE. AND AGENT
1 00, 14 Sep 04 OM 04) 6d.-/
SUMMARY OF INVESTIGATIVE ACITIVITY During a review of the statement provided by described he was abused by a US soldier while handcuffed toa rail the night. This occurred before being transported to the SIP. LT and LT imp related they handcuff the detainees to therail to Iteepthem separated. I will contact LT to see if they maintain a guard roster, 12 Jul 04 between the hours Of 0000 and 0600, so we can attempt to identify if this abuse occurred. I request we hold off on sending the status report until I can confirm the findings.
SAC: Rev'd and discussed with case agent. Noted/complete the following: 1. Hold off on sending stat unfounding, as a viable lead has been developed. 2. Re-coordinate with unit and determine if they maintained any type of duty
roster for the night in question. If so, obtain a copy and ID soldiers that need to be interviewed.
3. If nothing is developed from this, re-brief SJA with the additional lead we attempted and re-verify his opine. We will send stat at that time.
Case review 14 sep 04 noted. Will conduct all activity mentioned.
$41 Coordinated with 1LT who related no guard rosters are maintained and guard rosters are rotated based upon who is available and not on missions. 1LTIMMINIkelated a 15-6 investigation was conducted WV concerning this incident but could not provide the findings of the 15-6 or who it was conducted by.
Contacted 3-153 INF BN, to determine the location of the 15-6 investigation. I was informed both LTCIUMNIkuld MAJ1111111were in a meeting but due out shortly. Mink 'A &MAI Ote,S.
Contacted MAJ ho did not know who conducted the 15-6 86 90 11* 1 investigation. Ail provided their brigade legal as a POC CPT 00141.5
6461111147 tha
Attempted to contact CPT gill.with negative results.
CID FORM 28 I Oct 80
PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED 1-1 6
DODDOACID-004659 ACLU-RDI 87 p.35
-
14 Sep 04
AGENTS ACTIVITY f., MARY Control Number nnn (CID Regulation 195-1) 2M-04-m259-B0285 tral
SUMMARY OF INVESTIGATVE aczTxvrry TIME, DATE, AND AGENT SLAC: Rev'd. Noted/complete the following:
b7e.44.4,-/ Make minor corrections - a. Re-word second paragraph in summary. Mr.
OftAk$1,110did not make allegation against CF. b. date to all exhibit lines. See
correction of draft final. 2. Also, make a note in AAS why we are not
interviewing LT big s,66-3,
NaglFile back to SA for action. As already noted,
onceyou completemmtTradditional lead we discovered, we will move to the next step.
r3 Selo 0.1 69764,06e._/
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CID FORM 28 a Oct 80 PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED 7
DODDOACID-004660 ACLU-RDI 87 p.36
-
DODDOACID-004661
CID FORM 28 1 Oct 80
PREVIOUS EDITIONS OF THIS FORM WILL SE USED UNTIL EXHAUSTED - ki 8
SUM= Of massaarilm =min TIME, DATE, A} AGMT
AGENTS ACTIVITY SiderfaARY (CID Regulation 195-1)
Control Number 0249-04-C1D259-80283
: Rev'd. Noted/complete the following: OVvibig--/
1. Signed and transmig i.nal C. Posted same to
file. File to SPC for processing. -3
2. Forward per distro. I have already forwarded the email only copies.
3. Forward original file to CRC. 4. There was no evidence collected. 5. There is no 4833 required.
ACLU-RDI 87 p.37
-
CID FORM 66 1. DATE 2. TIME RECEIVED
0900 2 Aug 04 3. OFFENSE Aggravated Assault /Cruelty and Maltreatment
7. CASE NUMBER
0249-04-CID259-80283 8. ASSIGNED TO
4. SUBJECT . TYPE OF ACTION
GC Unknown
REPORTS COMP
tAn CY-j iqk
70104iily d4
1 to .S, SA C k)
ACTION RQRD COMPL DATE - AMOUNT
u L. 9
DODDOACID-004662 ACLU-RDI 87 p.38
-
W01, MP Special Agent in Charge
EPLY TO ATTENTION OF
,----`2160q -eiD ,75_ 80283 DEPARTMENT OF THE ARM__
38TH MILITARY POLICE DETACHMENT (CID) 22ND MILITARY POLICE BATTALION (CM)
CAMP COOKE, TAJI, IRAQ APO AE 09378
CIRF-CHD 24 Jul 04
MEMORANDUM FOR Special Agent in Charge, 78 th Military Police Detachment (CID), Camp
Victory, Baghdad, Iraq APO AE 09342
SUBJECT: Memorandum of Transmittal (0226-04-CID899)
1. On 21 Jul 04, this office received notification from the 39 th Brigade Combat Team (BCT)
Provost Marshal Office (PMO), Camp Cooke, Taji, Iraq APO AE 09378, who identified through Summary Interrogation Report (SIR) #1 CD-239-275-04-0217 and # ICD-239-275-04-0218, two detainees being held at the Brigade Interrogation Facility (BIF), Camp Cooke, Taji, Iraq APO AE 09378, claimed to have been beaten by American soldiers and soldiers from the Iraqi National Guard prior to their arrival to the BIF.
2. On 22-23 Jul 04, Intake and medical personnel working at the detention facility were interviewed as well as the detainees who claimed to have been abused. Statements were collected and documented from all involved parties. Further, detainee intake records and medical documents were also collected.
3. This investigation is being transferred to your office for action you deem necessary. a 7001.4-1 bito4,01., -/
4. POC is SA 1 cd.aikllm
Ends (1 8) 70.4,01-/ 1. AIR of SA 23 Jul 04 2. Sworn Statement of SGT1111111111M 22 Jul 04. M-94441 3. Sworn Statement of SPCIINIII.22 Jul 04. 6n BL-S/ 4. Sworn Statement of 1 LT Jul 04. 67r4641- V 5. Sworn Statement and translation of Mr 22 Jul 04. lin-iv,b4-
6. Sworn Statement of SO! 23 Jul 04. 67t -y,.64 -V 7. Detainee Information Log of
I0
DODDOACID-004663 ACLU-RDI 87 p.39
-
en.zcz,_ ey... CIO ell VW" 0 LittD75
)2 a3 Mr imp 7 Jul 04. A7C-Vib4 -41 8 I1anee Information Lo Mr , 17Ju1O4. 1 9. ati .Form 44 of SGT 10.CID Form 44 of MR' 11.CID Form 44 of MR 12.CID Form 44 of SGT 13.CID Form 44 of MS 14.CID Form 44 of SPC. 15.CID Form 44 of 2L 16.Cl]) Form 44 of SGT 17.CID Form 44 of SOT
of .#44-
r4-4344-4 r 64- r 7444.461-9
744.44-, AX-1144
71,Yabd -4/ on-eg,A4-y
X-3,7h6 18.Compact Disk 040226.919 containing images of detainee injuries.
2
DODDOACID-004664 ACLU-RDI 87 p.40
-
Page(s)
to - 13
Referred t
U.S. CENTRAL C MMA 7115 SOUTH B UNDARY BLV ATTN: CCJ6-D M A
CDILL AIR F RCE BASE FL DA 33621-5101 -
MS. J CQUELINE SCOTT scat centcom.smil.mil (813) 827-5341/2830
DODDOACID-004665 ACLU-RDI 87 p.41
-
DODDOACID-004666
AUTHORITY: 11118 10. United Slolos Code, Sidon 3012(51 ROUTINE USES: Your Milli moot, ru bet and Olhor poriono1 late Mtn ao veal B3 on oadificood I oitionote wa d EINOSotioso to Icalto Erg cnctrovioval
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DATE SUBMITTED
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SPONSORS IDOLS NAME ADOTINAL INFORMATION
SPONSORS SOCIAL SECURITY NUMBER SPONSORS GRADE / RANK SPONSOR'S MAGMA FAMILY RELATION JUVENILE PRIOR ECORD
SPONSOR'S UNIT 1 ORGANIZATION UNIT PHONE NUMBER SPONSORS INSTALLATION STATE COUNTRY ZIP CODE / APO
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ADDITIONAL INFORMATION
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ENO TIME DATE & OF INTERVIEW
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CORPORATION NAME FED SERV I PROD NUMBER PHONE NUMBER
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DATA REQUIRED BY THE PRIVACY ACT
ACLU-RDI 87 p.42
-
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DATA REQUIRED BY THE PRIVACY ACT AUTHORITY. TAN 10. Waled MORN Code. Sect= 3O12(p)
ROUTINE USES: Yew mad sooily nt, it and ofhor wand War olion am used as al addBonai Memel ears of Idandootan to (Dadra Sirtg and fathom'
PRINCIPAL PURPOSE: To provide CO enders and far maw= ant Math with DISCLOSURE: Dischnira of yew soma vainly nu her is vaAnlay. Me by Mach Ydr adon oy be acamesaldatiles
DATE SUBMITTED
-
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LOCAL ADDRESS
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START TIME DATE S OF INTERVIEW ADDMONAL INTERVIEW INFORMATION LOCATION OF INTERVIEW (START)
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YEAR OF VEHICLE
LOCATION OF INTERVIEW (END) PHOTO TAKEN
DISPOSITION I REMARKS
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DODDOACID-004667 ACLU-RDI 87 p.43
-
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DODDOACID-004668 ACLU-RDI 87 p.44
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DODDOACID-004669 ACLU-RDI 87 p.45
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1 53 VOW MT NAME 113 SPCA muce I ea SP:N MCC
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53 API 1 54 FAMILY REI 5: SKAWR LAST NAME
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ADMINISTRATIVE DATA TE...446 1 611,,ye Pliant 6 3 MiGEIGS CATS
ble'talkie I START 1 ilME ;6117"-.4
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START DATE ItfrE-:V
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CORPORATION DATA MIMI= NUMBER 75 M 111;11E0
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75 cDFORATION NAME
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2 81 PRP MP LCE
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FOR OFFICIAL USE ONLY - -18 e"./e.c.
DODDOACID-004670 ACLU-RDI 87 p.46
-
5 Year 4 SEQ Number 9 Control N
47 Zip Code/APO
Photo
81 Corp Zip Code
v , 40 -.)4-ciD899 -
(07/1 -?0 -cif:W-80283 ) INVESTIGATIVE WORKSHEET
DATA REQUIRED BY PRIVACY ACT AUTH ORfTY: Title 10. United States Code. Section 3012 (g)
PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified I REC Code
A4
ROUTINE USES: Your social security number and other personal information arc used as an additional/alternate means of identification to facilitate filing and retrieval. DISCLOSURE: Disclosure of your social security number is voluntary
8 Rel to Case 2 Action Code 3 Date Submitted 6 Unit I 7 ROI Number
INDIVIDUAL DATA
15 Other ID Number t"
BCC intc Height eig t tur ye
r I la) 34 Industry
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52 Zi Code
FAMI ER DATA lasei,g-v ilia 4 akv Ai. ,y 57 Sponsor Middle Name
59 SPON Grade 60 SPON MCAC 61 Sponsor Unit Address /
53 JUV
54 Family Rel
58 Social Security Number
55 Sponsor Last Nam e 56 Sponsor First Name
62 SPON City 1 63 SPON ST OFFENSE
65 SPON Zip Code/APO 64 SPON CTY
66 Offense Code 67 UFC 68 Offense Code 69 UFC 70 Offense Code 71 UFC 72 Offense Code 73 UK
ADMINISTRATIVE DATA Telephone
Place of Interview Stan
ETS
Date INTER V End
PCS/DEROS
Time INTER V End
Date INTER V Stan
Place of Interview End
Time INTER V Stan
Fingerprint
Vehicle Data Disposition
CORPORATION DATA
77 Corp Address 178 Corp City
82 Contract Number
NOTES
79 Corp State BO Corp CTY
74 Contractor Number 75 FED SERV/PROD I 76 Corporation Name
Cellular Phone Number: CID Form 44 -R (Automated) Edition of 1 Aug 87 will be used until exhausted
FOR OFFICIAL MC ONLY
. 19
6v4 Crz DODDOACID-004671 ACLU-RDI 87 p.47
-
38 Alias- Nickname(s) 39 Alias- Nickname(S) 37 Alias- Nickname(s}
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_0D25-s. 602E3 ) INVESTIGATIVE WORKSHEET
DATA REQUIRED BY PRIVACY ACT AUTHORITY: Title 10. United Stales Code. Section 3012 (g)
PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified I REC Code 2 Action Code 3 Date Submitted 4 SEQ Number
A4
ROUTINE USES: Your social security number and other personal information an: used as an additional/alternate means of identification to facilitate tiling and retrieval. DISCLOSURE: Disclosure of your social security number is voluntary
9 Control P 5 Year 6 Unit 7 ROI Number 8 Rd to Case
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Security 36 Physical Marks CI
23 Height 24 Weis
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//bll rkganization LI.
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42 Military SVC 43 Subunit 44 Fort/ City 45 State 46 Country 47 Zip Code/APO
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53 JU V 54 Family Rel 55 Sponsor last Name 1 56 Sponsor First Name 57 Sponsor Middle Name
58 Social Security Number 59 SPON Grade /
60 SPON MCAC 61 Sponsor Unit Address
62 SPON City 63 SPON ST 64 SPON CTY 65 SPON Zip Code/APO
OFFENSE 66 Offense Code 67 UFC 68 Offense Code 69 UFC 70 Offense Code 71 UFC 72 Offense Code 73 UFC
ADMINISTRATIVE DATA Telephone P ETS PCS/DEROS Date INTERV Start Time INTER V Start
Place of Interview Start Date INTERV End Time INTERV End Place of Interview End Fingerprint Photo
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CORPORATION DATA . 74 Contractor Number 75 FED SERV/PROD 4 76 Corporation Name
77 Corp Address 78 Corp City 79 Corp S ate 80 Corp CTY 81 Corp Zip Code
82 Contract Number
NOTES
Cellular Phone Number: CID Form 44-R (Automated) Edition of I Aug 87 will be used until exhausted
FORCFFIC:N (JI LY
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DODDOACID-004672 ACLU-RDI 87 p.48
-
INDIVIDUAL DATA
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uz z b -04-CID899'
(02 to *.roc,( 80283 )
INVESTIGATIVE WORKSHEET DATA REQUIRED BY PRIVACY ACT
AUTHORITY: Title 10, United Slates Code, Section 3012 (g) ROUTINE USES: Your social security number and other personal information are used as an addidonaliakanate means of identification to facilitate filing and retrieval.
PRINCIPAL PURPOSE: To provide commanders and law DISCLOSURE: Disclosure of your social security number enforcement officials with means by which information may be
is voluntary accurately identified 1 REC Code
A4 2 Action Code 3 Dale Submitted 4 SEQ Number 5 Year 16 Unit 7 ROI Number 8 Re! to Case 9 Control
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12-Eihnie 'Heigh t
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37 Alias- Niekname(s) 38 Alias- Nicknamets) 1 39 Alias- Nicknamets) e.,00 Organization
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42 Military SVC 43 Subunit 44 Fort/ City
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45 State 46 Country 47 Zip Code/APU
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58 Social Security Number 59 SPON Grade i
60 SPON MCAC 61 Sponsor Unit Address
62 SPON City 63 SPON ST 64 SPON CTY 65 SPON Zip Code/APO
OFFENSE 66 Offense Code 67 UFC 68 Offense Code 69 UFC 70 Offense Code 71 UFC 72 Offense Code 73 UFC
ADMINISTRATIVE DATA Telephone H ETS PCS/DEROS Date INTERV Start Time INTERV Start
Place of Interview Start Date INTER V End Time INTERV End Place of Interview End Fingerprint Photo
Vehicle Data Disposition
CORPORATION DATA 74 Contractor Number 75 FED SERV/PROD 0 76 Corporation Name
77 Corp Address 78 Corp City 79 Corp State 80 Corp CTY 81 Corp Zip Code
82 Contract Number
NOTES Aferv= E --C1",41-70r-3
nSoLS ) n
Cellular Phone Number: CID Form 44-R (Automated) Edition of I Aug 87 will be used until exhausted
FOR OFFICIAL USN ONLY
- 21
DODDOACID-004673 ACLU-RDI 87 p.49
-
15 Other ID
63 SPON ST 64 SPON CTY
(02409( -c1D2s7-0o783 ) INVESTIGATIVE WORKSHEET
DATA REQUIRED BY PRIVACY ACT AUTHORITY: Title 10, United Stares Code, Section 3012 (g) ROUTINE USES: Your social security number and other
personal information arc used as an additional/alternate
accurately identified enforcement officials with means by which information may be PRINCIPAL PURPOSE: To provide commanders and law
is voluntary DISCLOSURE: Disclosure of your social security number means of identification to facilitate filing and retrieval.
I REC Code 2 Action Code 3 Date Submitted 4 SEC) Number
A4 INDIVIDUAL DATA
..ust Name i:C'9/46PY Ad,/
5 Year 16 Unit 7 ROI Number 8 Rd to Case 9 Control N
Height
Position p
21 Race
32 MCAC
37 Alias- Nickname(s)
'Organization _t _if C _err
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).('Weight
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Educ Eye 27 C uzen
134 Industry ecurity 36 Physical Marks 4reg5J.
I 38 Alias- Nickname(s) 46 Country
51 Country
AMY FA BER DAT
Rad Pri Martial Ye":-S
47 Zip Code/AN)
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1 39 Alias- Nickname(s) 41 If Contractor. Contract N
45 State
53 JUV 54 Family Rel
58 Social Security Number
55 Sponsor Last Name
59 SPON Grade
56 Sponsor First Name
61 Sponsor Unit Address
57 Sponsor Middle Name
60 SPON MCAC
62 SPON City 65 SPON Zip Code/APO
66 Offense Code 67 UFC OFFENSE
68 Offense Code 169 UFC 170
Offense Code 71 UFC 72 Offense Code 73 UFC
ADMINISTRATI Telephone a ETS PCS/DEROS Date INTERV Start Time (NTERV Start
Place of Interview Stan Date INTERV End Time INTERV End Place of Interview End Fingerprint Photo
Vehicle Data Disposition
CORPORATION DATA 74 Contractor Number
77 Corp Address 78 Corp City 79 Corp State 80 Corp CTY 81 Corp Zip Code
75 FED SERV/PROD N 76 Corporation Name
82 Contract Number
NOTES
Cellular Phone Number: CID Form 44-R (Automated)
Edition of I Aug 87 will be used until exhausted - --22
OFF:CiAL en3 , C 17
DODDOACID-004674 ACLU-RDI 87 p.50
-
Page(s)
3 - 3G
Referred to CO)
U.S. CENTRAL COMMAND 7115 SOUTH OUNDARY BLV ATTN: CO
-6- M CDILL AIR FARCE BASE FLORIDA 3-3621-5101
MS. JACQUELINE SCOTT [email protected] (8]3)827-5341/2830
ACLU-RDI 87 p.51