This document is the standard Army form used when apprehending a prisoner. This form is completed and pertains to the apprehension of an Iraqi who was caught firing upon U.S./Coalition forces from his home and roof along with his two (2) sons in Baqubah, Iraq, November 22, 2003.
COALITION PROVISIONAL AUTHORITY FORCES APPREHENSION FORM .YELLOW FIELDS MUST BE FILLED IN, IF APPLICABLE, UPON APPREHENSION 0
Offense against CiviliAnts) [check one] If "Other then describe:
..Dir
Arson (I.P.C. 342)4..- .. , !Burglary or Housebreaking (I.P.0 428)
Solicitation of Fornication/ProsiitkAion,(1.P.C. 399) !Extortion/Communicating Threats (I.P.C. 430)
ID!Rape/Indecent/Sexual Assaults/Act4(I.P.C. 393-98, 402) !Theft (I.P.C. 439)
Murder (I.P.C. 405) !Destruction of Property (I.P.C. 477)
Aggravated Assault/Assault With Intent To Kill (I.P.C. 410) Obstructing a Public Highway/Place (I.P.C. 487)
Maiming (I.P.C. 412) Discharging Firearm/ Explosive in City/Town/Village (I.P.C. 495) Simple Assault tf.P.C. 415) !Riot or Breach of Peace (I.P.C. 495(3))
--- . ,
Kidnapping F.C. 421) Other
.„D.D,D....D.
leSta Offense_ : against Coalition Forces [check one] If "Other then describe:
Violation of Curfew QTrespass on Military Installation or Facility
Illegal Possession of Weapon Photographing/Surveilling Military Installation or Facility
47;ZIAssault/Attack on Coalition Forces QObstructing Performance of Military Mission
Theft:of.Coalition,Force Property I !Other
Apprehending Unit: A 58.,.§.04 I Location Grid:Dl'S 5 N¦c_.t0 73 41 3.:YD-?/ .Date.of. Incident (D/M/Y) Time of Incident: Date of Report: (D/M/Y) Time of Report: c,./ iiD/C53toa, / ) 1D/ 0 3 OA-(OD hrs to O430Dhrs -,J...?D/DI I.D/D15.? 1 / 1 5Dhrs
Detainee # Key Connected Person: 1D'Victim 1D'Witness
Last Name: Last Name:
First Name:D Given Name: First Name: Given Name:
Hair Color.DScars/Tattoos/Deformities: Hair Color. Scars/Tattoos/Deformities:
EyeColor.DWeight:Dlb Height:Din Eye-Color: Weight:Dlb Height:Din
Address: . -Address:
Place .of Birth: Place of Birth:
Ethnririlie/ ' Sex: Phone#: Ethn/Tribe/ Sex: Phone#:
Sect: Sect:
'M DOB INM/Y: I Mobile M DOB D/MN: D1 'Mobile IF I Regular I F . ID
'Regular
PassportDDr. license Other (specify) 'Passport I Dr. licenseDI Other (specify)
DocUrnent#: -Document #:
"Total'Nurnber of Persons Involved -L'.-- -"(listnames/identifying info on reverse under "Additional Helpful Information") D. I
I
Vehicle Information Vehicle NumberDofDVehicle(s) !Owner:
Make: Color. VIN:
Model: Type: Plate No.:D 'Number of People in Vehicle:
Year: Names of People in Vehicle:
Contraband/Weapons in Vehicle:
Property/Contraband ID'Weapon Photo Taken of Suspect with Weapon/Contraband: Yes/ No
Type: Model: Color/Caliber:
Serial No.: Quantity: 'Make: Receipt Provided to Owner Yes/ No
Other Details:D 'Where Found: Owner:
Name of Assisting Interpreter.D Email, Phone, or Contact Info:
Detaining Soldiers Name Supervising Officers Name
Print Print :
Si. nature: Sisnature:
Email: Email:
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DOD FINAL 342
DOD 57930
COALITION PROVISIONAL AUTHORITY FORCES APPREHENSION FORM
0D
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Why was this person detained?" D!-I 4-s Ca iv 80 c__7( 0Dp-r-i A f_-i 3 (-k.D
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Who witnesD•D r the reason for detention? Giv names, contact numbers, addresses.
A/5 Dry\-P DO-"JY\ tY\-
How was this person traveling (car, bus, on foot)? Pi -r 4-40DE-
Who was with this person? DIA( 3 cArr.
What weapons was this person carrying?DAK-14
What contraband was this person carrying? kj0k)6
What other weapons were seized? a C--C ACC t p 1,J1
D
What other information did you get from this person? f\f(DUE
Additional Helpful Information: L-Tc. 111111111D57`(1_.Df"-,010E`( (fr5E.44)z/,53D
t31) E62\-)( 0-7 c-Ca)-cv• 0,f)D c-vdR -t't-tcDt-3Af2. - E 413-
(..,Th 6 ti 5 v0 5u1 PP CC ,v.5 -LE •
DOD FINALD 343
DOD 57931