CID Report: 0099-04-CID389-80676

DEPARTMENT OF THE ARMY 75th MILITARY POLICE DETACHMENT (CID)(-) LSA DIAMONDBACK, MOSUL, IRAQ APO AE 09334
REPLY TO
ATTEAMON OF

CIRC (195-2) 6 Sep 2004
MEMORANDUM FOR: SEE DISTRIBUTION SUBJECT: CID REPORT OF INVESTIGATION FINAL — 0099-04-CID389-80676-5C2 DATES/TIMES/LOCATIONS OF OCCURRENCES:
1. 9 Aug 2004,1930 — 9 Aug 2004, 1940; MOSUL AIRFIELD DETENTION FACILITY; MOSUL, IZ. DATE/TIME REPORTED: 13 AUG 2004, 1000 INVESTIGATED BY: SA
SUBJECT: 1. (NONE); (NFI) [ASSAULT] [UNFOUNDED] lot-K & 16.
VICTIM: I . M; WHITE; CAPTURE TAG
earibIZ ; (NFI) [ASSAULT] [UNFOUNDED]
INVESTIGATIVE SUMMARY:

"This is an Operation Iraqi Freedom Investigation"
This investigation was initiated when Mr. IN/reported he was assaulted while in the Mosul
Detention Facility, Mosul, Iraq.

67e 46-1(
Investigation established Mr.411111claim of abuse was unfounded.
STATUTES: Article 128, UCMJ: Assault (Unfounded)
EXHIBITS/SUBSTANTIATION:
Attached:

‘4-1
20 Aug 04, detailing the Basis W-41. Agent's Investigation Report (AIR) of SA
for Investigation, interviews of M4NOSPCIII. and M and coordination with

9G if A frtc-
SJA.
FOR OFFICIAL USE ONLY- LAW ENFORCEMENT SENSITIVE
I
DODDOACID-004440
CIRC-CFC
SUBJECT: CID REPORT OF INVESTIGATION —FINAL - 0099-04-CED389-80676 — 5C2 (DIMIS)
bic-frX4-14
2. Sworn Statement of SPC 14 Aug 04, denying he assaulted Mr... Not Attached:
The originals of Exhibits 1 and 2 are forwarded with the USACRC copy of this report. Status: This is a Final Report.
Report Prepared By: Report Approved by:
1774 ,4
Special A.gen CW3, MP Special Agent in Charge DISTRIBUTION: 1 - DER, USACRC, Fort Belvoir, VA 22060 (original)
-
1 THRU: CDR, 22 nd MP BN (CID) (FWD), APO AE 09342 CDR, 3D MP GROUP (OD)
-?c 46
PMO, TFO (M (email only) -9.,
1 -COS, TFO (COL (email only) z 1-SJA (ATTN: CP , (email) I, 76--1/ b1 -File
2
DODDOACID-004441
'ROI NUMBER
AGENT'S INVESTIGATION REPORT
0099-04-M389-80676
CID Regulation 195-1
PAGE 1 OF 1 PAGES
DETAILS.
BASIS FOR INVESTIGATION: About 1000,113 Aug 04,

330 MP DET, LSA
Diamondback, Mosul Airfield (ASAP), Iraq, notified this office se abuse at Mosul
Detention Facility.
About 1400, 13 Aug A terviewed MR who stated thatduring interrogafion by MI Paisiiiniel
-on 9 Aug 04, he was
ti a he was in a L-76.4_,
kneeling position on ;V e floor with his hands behind his back.
that the air conditioner iffthe interrogation room was turned off and he began to sweat.
ted he moved to wipe the sweat
from his forehead when he was kicked by the interrogator ' the rigit leg above the knee' MR.41011g
:,..s ,
stated he did not report the incident or seek medical treatment, and he refused to provide a mitten -statement.
About 1000, 14 Aug 04, S advised SP 209 MI CO, 3/2 INF, of his rights, 47e-IC64-4
which he waived and provided a iwiurn statement. SP
enied kicking NIROOSee Sworn 67e-e, 64-4
Statement).
t)-7C-6 6 (0-(6 157c.--3/6-.3 67c--(4(‘-cc
About 1345, 14 Aug 04, SA interviewed MR.
Interpreter for MR who
stated that at no time during the interrogation on 9 Aug 04 did he or SPC__kick MR.
7C-fer-ce67C-ft 4-ctb
About 1415, 14 Aug 04, SA111.1111.re-interviewed MR.41111110who declined to provide a sworn
statement detailing the alleged incident.

b7e,-4 6 -4( 6 76-4/ 4.-3
About 1030, 15 AUG 04, SAMINIMpoordinated this investigation with C fiice of
the Staff Judge Advocate, who opined MR411111/allegation of abuse was unfounded. /// Last Entry ///
TYPED AGENT'S NAME AND SEQUENCE NUMBER ORGANIZATION
75th MP DET CID (-), USACIDC Mosul, Iraq APO AE 09334
DATE
EXHIBIT 31 Aug 2004
FOR OFFICIAL USE ONLY
DODDOACID-004442 3
- 1r ant v cr t
I INUA I
Fos use of this form. see AR 1.90-30; the
proponent agency is ODCEOPE
DATA REQUIRED BY THE PRIVACY ACT
AUTHORITY:
Title 10, United States Code_ Section 3012(0
PRINCIPAL PURPOSE:
To provide commanders and law enforcement officials with means by which information may be accu:atelv Your Social Security Number is used
ROUTINE USES:
DISCLOSURE:
as an additional/alternate means of identification to facilitate filing 2,-16 retrieveDisclosure of your Social Security Number is voluntary.

I. LOCATION
2. DATE
3. TIME

C ()FP ct
L r?, 1. 71tzt pc% tac Li4. FILE NO.
AV1
mmE.4.0A tMfl 79*-Oli-CiD C
ORCaNiZATION OR ADDRESS
a. .09 roc: 76
Ati . CO •
• GRADE/STATUS
3/4- :INF •
A
PART I - RIGHTS WAIVER./NON-WAIVER CERTIFICATE
Section A. Rights

& ti An 0..)b Q. A C 14. F
,,,,-
The investiigator whose rte.. e appears ,
below told me that hairJas is with the United States Army
/ (....ripAiPal6..Lr-Lic.541,4400p-,
suspected/aasuaad: 'A• S S A %.1 1 '1"' and wanted to question me aboi the following offense(s) of which I an he/she
asked me any questions about the off anse(s), however, he/she made it clear to me that I have the following rights:
o not have to answer any question or say anything,
riling I say or do can
be used as evidence against mein a criminal vial.

-
r personnel subject other UCMJ
uring I have the right to talk privately to a lawyer before, during, and after questioning and to have a lawyer present with ma questioning. This lawyer can be a civilian lawyer I arrange for at no expense to or both. the
Government or a military lawyer detailed for me at no expense to me.
- Of -
/For civilians not subject to the UCMJI
I have
the right to talk privately to a lawyer before, during, and after questioning
me during questioning. I understand that this lawyer can be
and to have a lawyer present wt:n one that I arrange (or a: my own expanse, or if I cannot afford a lawyer and wan: one, a lawye
II be appointed for me before any questioning begins.
am now willing to discuss the oftensejs

. under investigation, with or
speak privately with a without a lawyer present. I
have a right 10 size answering questions a: a
lawyer before answeJing fu.-..nu, even if I sign -ty time, o
the waiver below.
•
COMMENTS
1Continue on reve•se sloe)
ection B. Waiver
I understand my Fights as stated
above. I am now willing to dissusz
/laving a lawyer present with me. offer-se(s) under investigation and make a smartie= without talking to a lawyer first and witnoL-.
WITNESSES
(If available)
1 a. NAME
(Type or Print)
ORGANIZATION OE ADDR3SZ.1 AND PHONE
2a. NAME
(Type or Prins)
ears, e
ORGANIZATION OR ADDRESS AND PHONE
6.

OF INVESt1GAT
.Q ' (c,,
L •
Section C.
Non-waiver A i) ,44-4
j
I so no: wan: to give us my rigir.
0
I wan: 2 lawyer
0 I dr. not. warn to Pe questioner o-say En ythin
SIGNATURE
2. OF Ipri-ERViliviEE
TH:E.
, WAIVER CER71Fi:i-.7:: 7C+ ANY 3 1NC
-1F:b. 7.7.1- fr..:
-• •---- •-
4
DODDOACID-004443
SWORN STATEMENT
For use of this form, see AR 190-45: the proponent agency
r-316 -13
of The
for Personnel.
LOCATION

DATE
TIME FILE NUMBER
I
P`i pAc03611, •
00 7 6
SI e) -611111
GRWEIS171TUS
BCT
6
To MAKE a OATH-
64,
a4 • 4-
P.
'NI.",
.
0h P or //woke/gel in r
a orrreic
#4
•¦ • (
-6iJL
no • •4
J
Art e 0,4 e.'For.A s 17
ab,.A
ijn:gAt6cra@ct.;Kli-'S h
US- •-, ;I iskR r ?ers
ovind . -144 Unt-s
ed-licher/
L,Sreci.C..evt(l II . e n re
114 e4-611 {rum
6141 ohi 174 airirtin a -MI grenade.­
10.Iv I VS. a...;1 )1;6 4-inie.bn e. of • „ ace

niorrorm, 1"h2.
-
•
AA es
• • ottsreeN) CO id
nceini hie
1,1 e rneS •
/14 0 rOCA.P •
A •h -
4-0 i_din't 1 e .s r

4 0 VII
. S or Aet. s +Ina+
• " a ee
1 t (Ole vthard ' -Feu.) eb; pid es

c_04-1-hqued
4
4 - f
4k C.11
• ore o Vet —
rn Sled
V ch a4.-1
flu 0 IIl
e e

answer
CST' colt f'011
II
e COM 4 VO
C f7447 '2
• ec IV Lime rot( s
114 eS
-
4 to Q Pt A sirovi OCC iitnas•
Deb ' ee c•ki 'et 4 /0
S 0 ti s' r-15

va n e. Lif :Fin/ Sc.,
inn
COO re: a.
if

be. Serif 0
C.t •
• lG!.
LA/12.1
• • er170 ;n
k
z or k ii •
US' rrt
Ki CKs -1/1 his
6notyphe del.:fail/lee tuac
sir

ucK. (.y any force_
el-Annelr d r ibis 6 ()Mire leik 1
;rif e
XHIBIT
INITIALS OF PERSON MAKING STA
(:16-
PAGEjnF
PAF
ADDITIONAL PAGES MUST CONTAIN THE HEADING
°
STATEMENT OF TAKEN AT DATED CONTINUED ."
YE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE IN177ALS OF THE PERSON MAKING THE STATF_MENT AND BE
IITIALED AS PAGE OF
PAGES.°
NED our, WHEN ADDMONAL PAGES ARE UTILIZED, THE BACK OF PAGE 1 WILL BE
AND THE STATEMENT WILL BE CONCLUDED ON THE REVERSE SIDE OF ANOTHER r:npv np rum Clint
• 5

DODDOACID-004444
FILE NUMBER:

STATEMENT OF 51('' TAKEN AT .445.-11, 't") DATED 1 ayt CONTINUED
Q %.1e..5A\ riS "^i a 6Z — kil
A 14 6 3 6 -3

11,0 W.;
tv¦ ki Ih-t-err-rtrr ., ele --3
Q. WV,Ert $L a r tile i..) -r )1 kt p k a oz. 7. H-4c25 fiace
4 1, 6+ t F el-d • 0 -Gm;

• re4Jc. ; s risoriti 6Q ore'.
A'. Yes .

pA e,S7
AN f 0\4
A I-Lidice_6yi ottifsekc .
c23railtute knIrN7 Su c,h XS '41\nrc
• WAS L c).4 A e,;) etk) ?obi VI kAAL \,fs i
Li 4 1,, Ar.“-) A-01() Nc.) c( 40 ittoJc 7
4e r". 33) 40 heri--+o -e-I i ns fe &Evil 44_ et, 0 pvi j,vi,d 17; s
-400IY $c ?eh 61-rOrthq()Alitel
r .
‘4 ,a0 104n r_ .• ,A4-) 7A1.1-1e t-oct • 44 -Co vertu Q ) c dor; rlij %K 1,^•4 r vie 60.) diJ g c Ail- Co. a..).Jer
_+ r ',Jed Orr?
• Yes . A/c rereeAwily etniti work figitte44 Ac. tver 1.50
6-1--e--Lc ewe! 51 ishArtir5 41,2_ foredo v. S 41i iS fidtS here,he ei be-ft; re
• Al-A o r)1-) r I ri \VIN 14C.1-1-6 104 or) 411,,e,
k p riscwr eiNViNe r uJrzi51 C) AI or/

or ;Si
VO,

INITIALS OF PERSON MAKING STATEMENT PAGF riF j IDArZrzc:
DODDOACID-004445

FILE NUMBER:

STATEMENT OFSP G 41.111 TAKEN AT (flbsul is I DATED ISI AUG. 0 ki CONTINUED:
STATEMENT (Continued)
-
76
AFFIDAVIT
I, , HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT WHICH BEGINSIIMPIMII ON PAGE a. I FULLY 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 ORREINARDI.WHOUT-T OF PUNISHMENT,
. .,
AND WITHOUT COERCION, UNLAWFUL INFLUENCE, OR UNLAWFUL INDUCEMENT.
(ix:211 46
Statement)
WITNESSES: Subscribed and sworn to before me, a person authorized by law to administer oaths, this 101 day of p y . at 1,3A N #14:ein
-/
ORGANIZATION OR ADDRESS
6 6
tifiNeiton Administering Oath) 4
6-16-­
"
frypenkine Watering Oath)
ORGANIZATION OR ADDRESS

ART- is c
(Authority To Administer Oaths)
2 66.
INITIALS OF PERSON MAKING STATEMENT
PAGE 3 OF 3 PAGES
-(
7
DODDOACID-004446
MILITARY POLICE REPORT
For use of this form, see AR 190-45; the proponent agency is ODCSOPS
PRIVACY ACT STATEMENT .
AUTHORITY:

Title 10 USC Section 301; Title 5 USC Section 2951; E.O. 9397 dated November 22, 1943 (SSN).
PRINCIPAL PURPOSE:

To provide commanders and law enforcement officials with means by which information may be accurately identified. ROUTINE USES:
Your social security number is used as an additional/alternate means of identification to facilitate filing and retrieval. DISCLOSURE:
Disclosure of your social security number is voluntary.
MILITARY POLICE REPORT NUMBER DATE (YYYYMMDDI ORI NUMBER USACRC CONTROL NUMBER
0040-04 2004/08/13
THRU
TO FROM f &to-, # 004--07-7-, t t"." Tiplis ry's Pe7-
LSA 01...---,,,---1 /5­
-k-
SECTION I - ADMINISTRATION
1 REPORT TYPE

3. EVALUATION 4c COMPLAINT RECEIVED BY 5a. CLEARANCE REASON 5b. EXCEPTIONAL
— InfInformation X FFounded --In PPerson A Death of Offender CLEARANCE DATE
— —
Traffic (YYYYMMDD1
Unfounded 911
— B Prosecution Declined
—
Military Offense 4a COMPLAINT

_ CB C Extradition Declined
_
—
Criminal DATE Telephone D Victim Refused to Cooperate 7. INVOLVEMENT
—
—
!YY YYMMDDI
__.—.171 Complaint Mail E Juvenile, No Custody Hate Domestic
2004/08/12 — — — Radio U Unfounded Death Gang
—
— —
2. STATUS 4b. COMPLAINT Crime Stoppers X Apprehension Trainee Extremist
• —
X Initial TIME (24 HA))
Alarm 6a MP ACTION 6b DATE REFERRED Supplemental
_ —
X OTHER (Specify) MP Civil Authorities (YYYYMIVIDD)
— 1650
Cdr's Action — Electronic Mail 2004/08/13
X CID Traffic
—
)1 Referral MP OTHER (Specify)
SECTION II - OFFENSE (For additional offenses, complete DA Form 3975-11
1 a. OFFENSE NO.

1b. SUBJECT NO. lc. VICTIM NO.
1d. -NIBRS le. If. SAME OFFENSE DATA FOR ALL INVOLVEMENT INVOLVEMENT LOCATION CODE OFFENSE CODES
ATTEMPTED
i
1 '1 15
• —
COMPLETED —1 YES TINO See DA Form 3975-1 1g. OFFENSE
1h. OFFENSE DESCRIPTION(s) Alleged Prisoner li. OFFENSE LOCATION ADDRESS
CODEis)

Abuse. (Victim claims he was kicked above the right Mosul Detention Facility, knee by Interrogator while being questioned. LSA Diamondback, Mosul Airfield APO AE 09334
2a. BEGIN DATE
3. TYPE OF CRIMINAL ACTIVITY 4. OFFENSE STATUTORY 5. OFFENDER USED
treYYMMDDI
(Check up to three) BASIS (Check up to three)
2004/08/09
¦ B Buying/Receiving X A UCMJ A Alcohol
_
213. BEGIN TIME 124 Hour) C Cultivating/Manufacturing/Publishing B Non-Criminal Fatality C Computer Equipment
_
_ D Distributing/Selling C State D Drugs/Narcotics
_
—
2c. END DATE

E Exploiting Children D Local X N Not Applicable
— _
(YYYYMMDDI
0 Operating/Promoting/Assisting E Foreign
_ _
2004/08/09
P Possessing/Concealing F Federal, Non-UCMJ
2d. END TIME (24 Hour)

T Transporting/Importing
_
U Using/Consuming

NATIONAL INCIDENT BASED REPORTING SYSTEM (NIBRS) LOCATION CODES (Section II, Block 1d)
01 Air/Bus 'Train Terminal

10 Field/Woods/Training Area 19 Rental/Storage Facility
02 Bank/Credit Union

11 Government/Public Building 20 Residence/Ouarters/Barracks/BECl/BOO
03 Bar/Officer/NCO Club

12 Grocery Store/Commissary 21 Restaurant/Dining Facility
04 Church/Synagogue Temple

13 Highway/Road/Alley/Street 22 School/College
05 Commercial Office Building

14 Hotel/MoteINACINEO/TLQ 23 Service/Gas Station
06 Construction Site

15 Jail/Prison/Corrections Facility 24 Specialty Store/Concessionaire
07 Convenience Store/Shoppette

1 16 Lake/Waterway/Ocean 25 Child Care Facilitly/Home Day Care 08 Dept/Discount Store/Exchange
17 Liquor Store/Class VI 26 Recreation Area/Park
09 Drug Store:Hospital/Clinic

18 Motor Pool/Parking Lot/Garage 27 Training Center/Service School
I 28 On Board Ship
.... ....
DA FORM 3975, MAY 88, IS OBSOLETE PAGE OF 7
USAPA V I 00 8
DODDOACID-004447
.neck up
.hree and indicate in the second block next to the
whether:F • Fully Automatic S - Semi-Automatic M - Manual
U - Unknown
11 Firearm Rink Type)

35 Motor Vehicle 1 190 OTHER (Specify)
12 Handgun
50 Poison
13 Rifle
60 Explosives
14 Shotgun
4 65 Fire/Incendiary 99 None
7. NUMBER OF PREMISES ENTERED (For
40 Personal Weapons
70 Narcotics/Drugs
Burglary/Housebreaking only)
20 Knife/Cutting Instrument
85 Asphyxiation
30 Blunt Object
95 Unknown riForcible Entry riNo Forcible Entry
8. AGGRAVATED ASSAULT/HOMICIDE CIRCUMSTANCES (Check up to two) 9. ADDIT ONAL JUSTIFIABLE HOMICIDE CIRCUMSTANCES
R 1 Argument
20 Criminal Killed by Private Citizen
_
A Criminal attacked police officer and that police officer
2 Assault on Law officer
_ 21 Criminal Killed by Law Enforcement killed the criminal
3 Drug Dealing
_ 30 Child Playing With Weapon
-
B Criminal attacked police officer and was killed by
4 Gangland _ 31 Gun Cleaning Accident
another police officer
5 Juvenile Gang _ 32 Hunting Accideht
C Criminal attacked a civilian
6 Domestic Quarrel
_ 33 Other Negligent Weapon Handling D Criminal attempted flight from a crime
7 Mercy Killing ¦35 Other Negligent Killings
•¦••¦
E Criminal killed in commission of a crime
8 Other Felony Involved
F Criminal resisted arrest

10 BIAS MOTIVATION (As applicable( 1-1 YES n NO
1-1 UNKNOWN
G Unable to determine
SECTION III SUBJECT
(For additional subjects, complete DA Form 3975-2)
1a. SUBJECT lb. NAME
!Last, First, Middle, Jr., Sr., fill I
SSN/FNN/ALIEN REG NO
0. Unknown MI Interrogator 1 c. 1 d. PROTECTED IDENTITY le. CATEGORY
I f. DOB (YYYYMMOD1 1g. POB (City, State. Country)
lh. GRADE I I i. HOME PHONE
A Army
C Coast Guard

11. CITIZENSHIP
F Air Force 1'. WORK PHONE 1k. NICKNAMES/ALIAS 1 US Country (Specify)
H Public Health
Resident Alien

M Marine 1m. COMPONENT
ln. DRIVER LICENSE NUMBER
1 o IS LICENSE
N Navy G National Guard
FR Foreign State

(Specify)
ri
0 NOAA R Regular V Reserves
IT International
P Family Member 2a. ORGANIZATION, UIC, AND STREET ADDRESS

2b. INSTALLATION/CITY . ZIP/APO
CI Civil Service 209th MI Company
LSA Diamondback APO AE 09334
R Civilian 2c. STATE/COUNTRY
2e. UNIT PHONES Contractor
581111M
T Other Gov Empl 3a. RESIDENCE STREET ADDRESS 3b. INSTALLATION/CITY
3d. ZIP/APO
U Foreign Nat Empl
V Other Foreign Nat

3c. STATE/COUNTRY
W Retired Military
4a HAIR COLOR 4b. EYE COLOR

4c COMPLEXION
4d. AGE 5. JUVENILE
7. RACE
Brown Brown Albino Medium RANGE Blond A Asian/Pac. Islander
YES
Black Black (Specify)
Medium Brown
NO
B BlackDark Ruddy 6.
Black Gray SEX I AmericanGray Blue
Dark Brown Yellow.
4e. HEIGHT
MALE Indian/Alaskan NativeRed Green
Fair Sallow
FEMALE
W WhiteWhite Hazel Light
Olive
4f. WEIGHT UNKNOWN
U Unknown
Other (Specify) Violet
Light Brown
9. IDENTIFYING MARKS AND LOCATION
10. HOW DRESSED AT TIME OF INCIDENT8. ETHNICITY

(Clothing, Materials, Colors)
H Hispanic
N Not of Hispanic Origin

11. OFFENDER'S DISPOSITION
U Unknown
12. SECURITY CLEARANCE

13. MARITAL STATUS
14. SUBJECT ARMED WITH
(Check up to two and whether F - Fully
None Annulled
Automatic, M - Manual, S - Semi-Automatic, or U - Unknown)
Confidential Divorced
I
j I 1 Unarmed I
17 Club/Blackjack/KnucklesSecret Divorce Decree, Not Finalized 11 Firearm (Unk Type) 15 Other (Specify)-7 Top Secret_ Legally Separated
12 Handgun
Other (Specify) Married

13 Rifle Single
14 Shotgun Widowed 16 Lethal Cuttin Instrument
PAGE 2, DA FORM 3975, DEC 1998
PAGE 2-OF
USAPA V1.00
. DODDOACID-004448

=r1CINIDILIN I rrt 15c. APPREHENSION DATE
Jd. APPREHENDING PMO (UIC/MPC)
Accessor•
Military tYYYYMMOD/
Conspiracy

Surrender 15f. HOW DRESSED AT TIME OFPrinciple Civil Authorities 15e. DETENTION TYPE APPREHENSION
Solicit
Other (Specify)
N Non-Uniformed Svc.
U Uniformed Svc.
15g. DISPOSITION OF PERSON UNDER 18 YEARS

15h. FBI FORM 249 SUBMITTED
16a. INVOLVEMENT 16b. ALCOHOL/DRUG
H Handled Internally
El YES n M0 Alcohol TESTING RESULTS

R Referred to Other Authorities
(Specify)
15i. FBI FORM R-84 SUBMITTED
ri El NO Drug YES
None
16c. ILLNESS/INJURY
16d. ALCOHOL/DRUG INVOLVEMENT REMARKS

17a. CHEMICAL TEST TYPE 17b. DRUG TYPE
Blood Test

A "Crack" Cocaine G Opium M Other stimulantsBreathalyzer B Cocaine
H Other Narcotics
~ N BarbituratesSaliva Test C Hashish
-I LSD
_
-0 Other Depressants
Urine Test D Heroin

J PCP
_ P Other Drugs
Other (Specify) -
~ E Marijuana
K Other Hallucinogens
-0 Steroids
F Morphine L Amphetamines/Methamphetamines U Unknown Type Drug
17c. DRUG TEST AND MEASUREMENT
(i.e.,parts per million cubic centimeters, etc.)
17d. DRUG DETECTION BY OTHER LAW ENFORCEMENT MEANS
f1 YES riNOSECTION IV VICTIM
(For additional victims, complete
DA Form 3975-3)
1a. VICTIM NO.
1c. SSN/FNN/

NUMBER
1 1 d; ROTECTED IDEtITITY
Capture Tag #
1e. CATEGORY
1g. POB (City, State, Country)
A Army 1h. GRADE
Iraqi National
C Coast Guard 1i. HOME PHONE 1'. WORK PHONE 1k. NICKNAMES/ALIASF Air Force
H Public Health 1L CITIZENSHIP 1m. COMPONENT 1n. DRIVER'S LICENSE NUMBERM Marine US
G National Guard
N Navy
Resident Alien -
R Regular
1o. IS LICENSEO NOAA
X Country (Specify)
V Reserves
FR Foreign State
P Family Member Iraq (Specify)
•••¦•¦•¦
IT International
O Civil Service 2a. ORGANIZATION, UIC, AND STREET ADDRESS
2b. INSTALLATION/CITY
X R Civilian Mosul Dention Facility 2d. ZIP/APO
9, 3 -31. 1
S Contractor LSA Diamondback 4514 r)C4t r544.
T Other Gov. Empl. Mosul, Iraq, APO AE 09334 2c. STATE/COUNTRY 2e.

UNIT PHONE
U Foreign Nat'l Empl tr% Cd S
3a, RESIDENCE STREET ADDRESS 3b. INSTALLATION/CITY
V Other Foreign Nat'l 3d. ZIP/APO
W Retired Military
3c. STATE/COUNTRY

4a. TYPE OF VICTIM
4b SEX 4c. AGE 4d RACE
B Business 4e ETHNICITY
R Religious Org
X Male
Under 24 Hours
A Asian/Pacific Islander
F Financial H Hispanic
S Society/Public Female 1-6 Days Old
B Black
G Government X N Not of
Other Unknown
ays Old
I American Indian/Alskan - Hispanic Origin
X ! Individual
Unknown Years Old Native U Unknown
AGE RANGE (Specify)
RW White
U Unknown
5. BIAS MOTIVATION I

I YES U N
(Check applicable bias)
AK Anti-Female Homosexual AU Anti-ProtestantAA Anti-Atheist/Agnostic AL Anti-Heterosexual AV Anti-WhiteAB Anti-Alaskan Native AM Anti-Hispanic
AC Anti-American Indian AW. Anti-Homosexual Bias
AN Anti-Islamic (Moslem)

AD Anti-Arab AY Anti-Other Religions
AO Anti-Jewish

AE Anti-Asian AZ Anti-Other Ethnicity
AG Anti-Male Homosexual

AG Anti-Bisexual BA Anti-Mental Disability
AR Anti-Multi-Racial Group

AR Anti-Black BB Anti-Physical Disability
AS Anti-Multi-Religious Group

BC Sexual Harassment AT Anti-Pacific-Islander
Al Anti-Catholic
, AX Unknown Bias
PAGE 3, DA FORM 3975, DEC 1998 ¦¦•1111MMEMPOIS11.01
PAGE _ 3 OF 2
USAPA V 1.00

DODDOACID-004449 10
the sublecr's number)
TI
AA Spouse
AB Child
¦
AC Sibling AD Parent AE Parent-in-Law AF Step Child

¦
AG Grandparent

¦
AH Step-Parent AK Grandchild

vrrcisi
None
AV Step-Sibling AZ Friend
BA Neighbor
BB Corn. Law Spouse BC Acquaintance BD Baby-Sittee (baby) BE Boy/Girlfriend BF Child of Boy/Girlfriend EH Former Spouse
(tor multiple offender relationships, enter
SECTION V - PERSONS RELATED TO REPORT
BL Homosexual Relationship BN Extended Family BY Employee az Employer BX Stranger CA Otherwise Known CB Relationship Unknown VO Offender
••••••¦••
7.
Accessory PrincipleINVOLVEMENT
Conspiracy Solicit
8. INJURY TYPE (Check up to five)
B Broken Bones

• 0 Major Injury Ill I Possible Internal 111 T Tooth Loss
L Severe Laceration ¦ U Unconsciousness
• NI Minor In' ry ¦ Z None 9a DO FORM 2701 PROVIDED VICTIM
ED YES ED NO 9b. IF NOT PROVIDED, WHY NOT?
n Declined n Not Required
(For additional persons related to report, complete DA Form 3976-41
a. PERSON RELATED TO REPORT NUMBER lb. STATUS
Civil Authorities
111 Complaint aMilitary Police Sponsor
X Witness
1c. NAME (La Jr., Sr., 1111 1 d. SSN/FNN/ALIEN REG NO. le. CITIZENSHIP

1 X US I I Re 'dent All
1g. bele IVVYYMMDDI lh, Fos le, County)
1j. .HOME HONE
lk. WORK 11. NICKNAMES/ALIAS
1 m. COMPONENT G Nat'l Guard R Regular V Reserves
¦
¦
a

DRUG/NARCOTIC MEASURES
GM-Gram KG-Kilogram OZ-Ounce LB -Pound FO-
Fluid Ounce GL-Gallon LT-Liter ML-Milliliter DU-Dosa e Unit NP-Number of Plants
PAGE 4, DA FORM 3975, DEC 1998
PAGE 4/ OF 7
USAPA V1.00
• I
DODDOACID-004450
iviiu I ARY POL
.
,E REPORT - ADDITIONAL PERSONS RELATED TO REPORT
For use of this form, see AR 190-45; the proponent agency is ODCSOPS
This form is a continuation of SECTION V, DA Form 3975.
Please attach it to DA Form 3975 when completed.

PRIVACY ACT STATEMENT
AUTHORITY:
PRINCIPAL PURPOSE: Title 10 USC Section 301: Title 5 USC Section 2961; E.O. 9397 dated November 22, 1943
ASSN/.
ROUTINE USES:
To provide commanders and law enforcement officiate with means by which information may be accurately identified. DISCLOSURE: Your social security number is used as an adiStionaUaltemate means of identification to facilitate filing and retrieval.
Disclosure of your social security number is voluntary.
1. MILITARY POLICE REPORT NUMBER 2. DATE (YYYYMMDD) 3. ORI NUMBER
0040-04
2004/08/13 4. USACRC CONTROL NUMBER

5. THRU
6. TO
7. FROM
SECTION V - PERSONS RELATED TO REPORT
1a. PERSON RELATED TO REPORT NUMBER
lb. STATUS
Civil Authorities
2 Complaint
Military Police (La .Firs Mi a Witness
c. NAME Sponsor
Me, Jr Sr.,
1 d. SSN/FNN/ALIEN REG NO.
le. CITIZENSHIP
US Resident Alien
11. CATEGORY Country (Specify)
1g. DOB IYYYYMAIDO ha
A Army lh. POB (City, Stare, County)
Baghdad, Iraq li. GRADE lj. HOME PHONE C Coast Guard Civilian
F Air Force 1k. WOR

PHONE
11. tCICNAMES/ALIAS
I-1 Public Health
to
.1•P 1 m. COMPONENT
G Nat'l Guard M Marine
R Regular
ln. DRIVER LICENSE NUMBER V Reserves
10 IS LICENSE
N Navy State (Specify)
Other (Specify)
Foreign
0 NOAH
International
2a. ORGANIZATION, UIC, AND STREET ADDRESS

P Family Member
Q Civil Service Titan Linguist 2b. INSTALLATION/CITY 2d. ZIP/APO
R Civilian (Working for 107th FA at MDF) LSA Diamondback APO AE 09334 S Contractor 2c. STATE/COUNTRY
2e. UNIT PHONE T Other Gov..Empl. Iraq
5891111k
3a. RESIDENCE STREET ADDRESS
¦ U Foreign Nat'l Empl. 3b. INSTALLATION/CITY
3d. ZIP/APO
¦ V Other Foreign Nat'l
W Retired Military 3c, STATE/COUNTRY 4a.
DD FORM 2701 PROVIDED VICTIM/WITNESS 4b. IF NOT PROVIDED, WHY NOT?
5. NUMBER OF VICTIMS AND WITNESSES NOTIFIED
Declined 13 Not Required
El YES El NO WITH DD FORM 2701
0
)A FORM 3975-4, DEC 1998
• PAGE
OF 7
1JSAPA V1.00
DODDOACID-004451' 2
LXJ Military Police
¦ Witness
to. IS UCENSE
c. NAME (Last, First Middle Name, Jr., Sr., Ill) 4C0' Sponsor 1 e. CITIZENSHIP a US 11 Resident Alien
I f. CATEGORY A Army C Coast Guard 1g. DOB fYYYYMMDD) 1h. POB (City, State, County) 1 i. GRADE E-5 1 j. HOME PHONE
F Air Force
H Public Heatth 1 m. COMPONENT G Nat'l Guard
M Marine in. DRIVER LICENSE NUMBER R Regular V Reserves

N Navy Foreign
0 NOAA
InternationalP Family Member 2a. ORGANIZATION, UIC, AND STREET ADDRESS INSTALLATION/CITY
O Civil Service 330th MP Det. (L&0) 2b. 2d. ZIP/APO
LSA Diamondback
R Civilian APO AE 09334 S Contractor 2c. STATE/COUNTRY
2e. UNIT PHONE
Iraq6
T Other Gov. Empl. 5891111th
3a. RESIDENCE STREET ADDRESS U Foreign Nat'l Empl. 3d. ZIP/APO
3b. INSTALLATION/CITY
V Other Foreign Nat'l W Retired Military 3c. STATE/COUNTRY 4a. DD FORM 2701 PROVIDED
4b. IF NOT PROVIDED, WHY NOT?
VICTIM/WITNESS 5. NUMBER OF VICTIMS AND WITNESSES NOTIFIEDDeclined Not Required
ri
WITH DD FORM 2701
0
1 a.
PERSON RELATED TO REPORT NUMBER
1 b. STATUS Civil Authorities
4 Complaint
Military PoliceSponsor
Witness
Resident Alien 1 f. CATEGORY
1g. DOB fYYYYMMOD) 1 h. POB (City, State, County)
A Army 1 i. GRADE
1'. HOME PHONE C Coast Guard E-6 F Air Force
H Public Health
1 m. COMPONENT
G Nat'l Guard M Marine 1n. DRIVER LICENSE NUMBER R Regular V Reserves
1 o IS LICENSE
N Navy State (Specify) Other (Specify)
Foreign
O NOAA International

P Family Member
2a. ORGANIZATION, UIC, AND STREET ADDRESS Q Civil Service 330th MP Det. (L&O) 2d. ZIP/APO R Civilian
APO AE 09334 S Contractor 2c. STATE/COUNTRY
2e. UNIT PHONE
Iraq

T Other Gov. Empl.
3a. RESIDENCE STREET ADDRESS 58911111E, U Foreign Nat'l Empl. INSTALLATION/CITY
3b.
3d. ZIP/APO V Other Foreign Nat'l 3c.
W Retired Military STATE/COUNTRY 4a. DD FORM 2701 PROVIDED
4b. IF NOT PROVIDED, WHY NOT?
VICTIM/WITNESS 5. NUMBER OF VICTIMS AND WITNESSES NOTIFIED

riDeclined
Not Required WITH DD FORM 2701riYES
NO 0
PAGE 2, DA FORM 3975-4, DEC 7998
PAGE
OF 2
USAPA V 1.00
DODDOACID-004452 I 3
SECTION VII -NARRATIVNARRATIVE: On 13 August 2004, at approximately 1010, I (SSGthe the 330th MP Desk Sergeant. The e-mail was from MAJOR was given an electronic message (E-Mail) by
m e Task Force Olympia Provost Marshal's
()flier. asking for a member of our unit to conduct an initial investigation into an abuse claim
Mosul Detention Facility on LSA Diamondback. At approximately 1040, myself and SG aprisoner that is detained in the

with SSG6from
. rom the 330th MP Det. met
the Mosul Detention Facility and advised him we needed to meet with the juvenile detained there that
Liming he had been abused by an interrogator while he was '.. , u.estioned . 107th FA's Interpreter JAAF accompanied us

was..egregation cell #5 to retrieve the complainant (Capture Tag# . .. to
-et iierer-if
INTERVIEW OF COMPLAINANT:.

At.a ro
ricaM, ¦A'e identified asima xithatel. „1-045 we interviewed the victim in.an interrogation room at the p

pilinamai rison. Th
. llirearanr a'
interrogated live to six urates " . d us that since his capture on 2 August 2004 he
y. our Inhterrogators. ' 'd had bee
K.
e had been treated very weitifiyggcv.out of the
four Interrogators and that there was alWays an interpreter preSt5tit dunng e Interrogations. Accord 10,
time he was interrogated •6 e last
was on 09 August 2004. During the inter rogati the Interrogator made
knees, put his hands behind his..back and .., , ., . et down on
knees being questioned not o ma e any sudden movements. However diiiin
—g' de time he was on his
then screamed at by the hie'''to wipe sweat off of his brow, and was then kicked just above his right knee and
. ter:
incident but it left no red mark or b Id us that the kick caused him pain for approximately two hours after thet, see a doctor for the knee. I asked Atiltritiere has been no further pain. He has not received.any.medical treatment or asked wanted to he released r a written statement concerning the incidentAtiKhesefused and stated
from the prison • he
s tely 1055, I took two digital photographs offellanalli one of his knee
showing no signs of injury and one o
___IC • • .
. ( .
August _004, we concluded the interview with 6e ee that he claimed was laeked. At approximately
•
d released him back to his cell.
REFERRAL:
io him At approximately I 105hrs on 13 Augustillialkind I informed CID Agentallapf the incident and referred
the
bgt '31(00-3
[15104 L
1. ENCLOSURES 2. DISTRIBUTION
21-Digital Photographs. One of Cimplainant and one of complainants knee.
4; Detdinee Custody Forms. Dated: 04 August 2004, 05 August 2004, 05 August 2004 and 13 .August 2004. E-6 5. TITLE OF REPORTING OFFICIAL Military Police Investigator
4. SIGNATU C

PAGE 5. DA FORM 3975• DEC 7998
PAGE 76OF 7 usaaa
v, CC
1 4
DODDOACID-004453
UNCLASSIFIED - FOR OFFICIAL USE ONLY

DATE:614 Aug 04
FROM:6SAC, 75TH MP DET CID (-), MOSUL, IRAQ
TO:6DIR, USACRC, FT BELVOIR, VA
CDR, 75Th MP DET (CID), BALAD, IRAQ
CDR, 22ND MP BN (CIDXFWD), BAGHDAD, IRAQ
CDR, 3D MP GRP (CB)), FT GILLEM, GA
CDR, ATTN: CIOP-ZA, USACIDC, FT BELVOIR, VA
PM, STRYKER BRIGADE COMBAT TEAM (SBCT), MOSUL, IRAQ
SJA, SBCT, MOSUL, IRAQ
PM, TASK FORCE OLYMPIA (TFO), MOSUL, IRAQ
SJA, TFO, MOSUL, IRAQ
CHIEF OF STAFF, TFO, MOSUL, IRAQ
SUBJECT: CID REPORT OF INVESTIGATION - INITIAL/SSI - 0099-04-CID389-80676-
5C2
DRAFTER:
RELEASER:
1. DATES/TIMES/LOCATIONS OF OCCURRENCES:
1. 9 Aug 2004,1530 - 9 Aug 2004, 1530; MOSUL AIRFIELD DETENTION FACILITY; MOSUL, IZ.
T DATE/TIME REPORTED: 13 Aug 2004, 1000 6-‘
3.
INVESTIGATED BY: SA

4.
SUBJECT: 1. (NONE); (NFI) [ASSAULT] [UNFOUNDED]

5.
VICTIM: 1.6 , M; WHITE; CAPTURE TAG #111011WIZ; (NFI) [ASSAULT] [UNFOUNDED]

6.
INVESTIGATIVE SUMMARY: THE INFORMATION IN THIS REPORT IS BASED UPON AN ALLEGATION Oct PRELIMINARY INVESTIGATION AND MAY CHANGE PRIOR TO THE COMPLETION OF THE INVESTIGATION.

"THIS IS AN OPERATION IRAQI FREEDOM INVESTIGATION"
THIS INVESTIGATION WAS INITIATED WHEN THIS OFFICE WAS NOTIFIED BY 330TH MILITARY POLICE DETACHMENT, MOSUL AIR FIELD, MOSUL, IRAQ, OF A REPORTED DETAINEE ASSAULT AT MOSUL AIRFIELD DETENTION FACILITY.
40 91. A11_66 -11 PRELIMINARY INVESTIGATION DISCLOSED ON 13 AUG 04, MR. VIP REPORTED HE WAS KICKED DURING INTERROGATION THAT OCCURRED ON 5 AUG 04.

,14,3„1/67-q.,
ON 13 AUG 04. Jew w AS INTERVIEWED AND STATED HE WAS PLACED ON HIS KNEES AND SEARCHED AND INSTRUCTED NOT TO MOVE. MR. ',STATED HE UNCLASSIFIED - FOR OFFICIAL USE ONLY 419C`11/66 ' Li
6 1 5
DODDOACID-004454
UNCLASSIFIED - FOR OFFICIAL USE ONL

WAS SWEATING AND MOVED TO WIPE HIS BROW, WHEN HIS INTERROGATOR, SPC 1111111111111111111111111111111111111.209TH MILITARY INTELLIGENCE CO, MOSUL, IRAQ, (FT
afc•cfk/94/
LEWIS, WA), KICKED HIM IN THE LEG, JUST ABOVE HIS KNEE. MR.. apsTATED
THE KICK DID NOT LEAVE ANY MARKS OR BRUISES AND DECLINED TO PROVIDE
A WRITTEN STATEMENT.
g•t(IF
. -
ON 14 AUG 04, SPCC WAS INTERVIEWED AND DENIED KICKING MR. y
ON 14 AUG 04, MR. INTERPRETER, T th iA y * r ' ORATION, MOSUL
AIR FIELD, MOSUL, IRA: WAS INTERVIEWED. MR. STATED HE WAS
PRESENT WHEN SPC iiii!INTERROGATED MR. MON 5 AUG 04, AND STATED SPC
DID NOT KICK MR. grAS ALLEGED. 414C-4/696,1(
kirer-if jar_ifFig-eit64 .4-1
4,
'
ON 14 AUG 04, l .11111KTAS RE-INTERVIEWED AND AGAIN DECLINED TO PROVIDE
A WRITTEN STATEMENT, AND INDICATED HE DID NOT WANT TO PURSUE THE
MATTER ANY FURTHER

tota-q

A REVIEW OF THE DETENTION FACILITY RECORDS DISCLOSED ID NOT
SEEK MEDICAL ATTENTION, NOR DID HE DOCUMENT THE ALLEGED ASSAULT ON
DETAINEE CUSTODY FORMS AFTER HIS INTERROGATION.. MR.1111111COULD NOT
EXPLAIN HIS DELAY IN REPORTING THE ALLEGED INCIDENT. toqc-L1,i
TERMINATION OF THIS INVESTIGATION IS PENDING PROCESSING OE THE FINAL
REPORT.
7. CID REPORTS ARE EXEMPT FROM AUTOMATIC TERMINATION OF PROTECTIVE MARKINGS IAW CHAPTER 3, AR 25-55.
UNCLASSIFIED - FOR OFFICIAL USE ONLY
7
DODDOACID-004455' 1
SEQUENCE NUMBER
INVESTIGATIVE PLAN
oa/9-cro3 yl rag 7 e-
Subject (06-6 Victim: t-Type of Case: Assigned To::
c -Ebiel

AA , ASsovi+ t
•
DATE NOTED PLANNED ACTIVITY
COMPLETED
1 3 Au,N ci 7 17-- ' ,1^e, r v 1 c . . 46ft% fi...
i3 4..5tc,i
1tA-A, 'I t i 5 r c . .attei Ali
I 4 . ,.„-,,, ,, ,-„, b c, -3 At J`f
AN.0

• o
•
•
-

MISCELLANEOUS ACTIVITY .
ACTION COMPLETED
ACTION COMPLETED
Obtain MP Report . Sources targeted
a
NCIC entry on stolen prop . Medical records requested
.
Film submitted for contact sheet . Name check dispatched
.
2701s issued to all of the . Name check results received
.
victims sand wi , ,1 esses
CONTACTS/PHONE NUMBERS 'N'VEST1GAT!VE STANDARDS
ACTIVITY/PERSON PHONE NUMBER VICTIMS INTERVIEWED 24 hours EYE WITNESSES INTERVIEWED 24 hours EVIDENCE DEPOSITED 1 duty day
LAB REQUESTS 5 duty days
RFAt SENT OUT 5 duty days
MEANINGFUL INV ACTIVITY 10 duty days
RFA FOLLOW UP 15 duty days
KNOWN SUBJ FINALS 15 duty days
UNFOUNDED FINALS 15 duty days
• UNKNOWN SUBJ FINALS 30 cal days
-1
DODDOACID-004456
CID Form 66
1. Date: 2. Time Received: 7. Case Number:
13 Aug 2004 1000 0099-04-C1D389-80676
3. Offense(s): 8. Assigned To:
Assault (UNFoovacti) SAllifif
4. Subject(s): 9. Type ofActienn:
Unknown
ROI
15.Viletim(s) 0 , , q 13-1­eit iU0(0-4, Capture Tag # 1 Suspense Completed
fre
16. Case Description:1
. .4 -
During an Iraqi Mosul Councel visit to the prison, Mr.
reported to the visitors that he was kicked in the leg while sitting on the
ground by a US Soldier who was interrogating him. 6,,iivAia e..4)
This is an Operation Iraqi Freedom Investigation.
, 1 .tOther Action 12. CID Funds
Action Re • uired Com i leted Date Amount
uamnal Info
!Evidence Cust

IIIIIIIIMIIIIIIIII
DODDOACID-004457
liMICIINIMNS=11111¦1111M11=11¦
AGENTS ACTIVITY SUM.....ARY Control Number
(CM Regulation 195-1)

0099-04-059389-80676 DATE, AND AGENT
SUMMARY OF INVESTIGATIVE Acrrivnit
1000 ; 11166001 Rtc;vta rerA p,„,?;‘,Ic fr ; sc,,, 4 1,st
,A+tvs,,I ;I-F/6d corc,;),11 41 330 folP

0-100,11 Ao s r v
CdonTIAir4,-. 1
Sri WHIP 14 Ln F) Java-) (/a c. 147 Oak. Ai r

`. (
woo, 11-1 Ao 01 v tb-10 c.) Ar dt/4; S
Worr 5 vl AdcrrfI fie"
Mat
St:-S Q a 0; M I Co (v3F),6
S or NJ
4.C-t ba-1
64. rac avc6.
11;45 11,15 01
rci r
S kill.

(..‹.cPik)
1c4C ­
(

61crci ( b6"(
A-a5
k or Gh4F)
F-111 1,121

5A 11111111, A • I-)
Pi•
6 `' •
-64-eye E,V7I1
006-bri-2) 441/1t41j. "1- A-Cre/54e-xc,v
103e Jl3 Agaro 9.

WOW (91C"f(
DODDOACID-004458
IMPbill
taXil I NUL PAW
(CID PcsailaiL _
-
O ee4,19 77--
Tem DAS A AGENT
SOURCARY OF litiVESTlioAllitiE ACINITY
AfttiutAse,s- G AArc-zeeErSIg-Le n e7-e/4-
6-7,4

lib-3
OAA `/1J49? *.a

/0 4,6,_ 8 5;fe 474161/
Oqc-t / b6.-( 74 147-e-21006---"eur 2. .14-$1 cf,771 eee'lt,d/A*1 7eov 7­0 /44 'Ai.
47447
Ag60171tE
fc K-r' acria4
16'44" (06
C, 1 "lei . I "4-4' 6Fu/ rev, et-) .
Mar
64c.-t
i Air of A-viegkez
6,44 rizircr—f emes-ewesis- N6 b.-4 -re 40-.06-/4-34,-AV fr "Ate:
---- 414 Araffi itAtivat zlo 63--ht /Pr-
Cdrr-c4.,)(d.-/s "i4le6 tjAlvei fri/cal )1 0
eoLtAi =t
f7N Pc.' v5h3/4- 1)/ C ,(e
1 OCT 80

DODDOACID-004459 4

DATA

LAST N
.41
21
1 So

MOS 6.
ri......mae
ALMS-NICKNAME IF CCI4TRACTOR-CONTRACTO
ORGANIZATION
.)-i
..c;' ci Anor Co-3 l•/
STATE cry pCODE
MILITARY SVC SUBUNIT FORT/Cr , 1-. 1-e-i-16
l.' L") 4 STATE cry CODE
CITY
FAMILY MEMBER DATA SPONSOR FIRST NAME (SPONSOR MIDDLE NAME
ADDRESS
B.Pit-(FAMILY REL SPONSOR LAST NAME SPONSOR MCAC SPONSOR UNIT ADDRESS
SOCIAL SECURITY NUMBER -SPONSOR GRADE SPONSOR VI' CODE/APO
SPONSOR an, SPONSOR STATE SPONSOR CTY
OFFENSE IUFC 'OFFENSE CODE 'UM `OFFENSE CODE IUPC OFFENSE CODE UFCOFFENSE CODE
ADMINISTRATIVE DATA ETS PCS/DEROS IsITIE INTER TIME INTER
TELEPHONE# ART START
g-A C501-—457-TIME INTER PLACE OF INTERVIEW 'FINGERPRINT PHOTO
PLACE OF INTERVIEW DATE INTER END DID
START END DISPOSITION
VEHICLE DATA ' CORPORATION DATA CONTRACTOR# IFED SERV/PRODO (CORPORATION NAME rcap.sy ICORP-CTY (CORP ZIP CODE
CORP ADDRESS (CORP-CITY CONTRACTOR NUMBER
I. --.------4 I., _..1
gams 171-0 -
DODDOACID-004460 5

YESTIGATIVE WORKSHL T

INDIVIDUAL DATA

GRADELAST NAME
ER
FRNIIIIPb 4C -4 (i647-4
SOCIAL OTHER rt 4 Ps FOB-ST CTY
SEX RACE ETHNIC mow WEIGHT HAIR BYES PIOR RECORD MARITAL
In tiJ 63`, I?" Xle M 7- 1 d MOS MCAC POSITION INDUSTRY sO.cuarrr PHYSICAL MARKS
-
ALMS-NICKNAME ALIAS4IICXNAME
[Ams44001AmE
1
ORG TION 'II/ CONTRACTOR-CCINTRACT#
MILITARY SVC SUBUNIT FORT/C1TY STATE CTY ZIP CODE
ADDRESS CITY STATE CTY ZIP CODE
FAMILY MEMBER DATA 31.1T/ 'FAMILY REL SPONSOR LAST NAME SPONSOR FIRST NAME 'SPONSOR MIDDLE NAME
SOCIAL SECURITY NUMBER SPONSOR GRADE SPONSOR MCAC SPONSOR UNIT ADDRESS
SPONSOR CITY SPONSOR STATE SPONSOR CTY SPONSOR ZIP CODEFAPO
OFFENSE OFFENSE CODE UPC OFFENSE CODE OFFENSE CODE UFC OFFENSE CODE UFC I
ADMINISTRATIVE DATA TELEPHONE# TITS PCS/DEROS DATE INTER TIME INTER
START START PLACE OF INTERVIEW DATE INTER TIME INTER PLACE OF INTERVIEW FINGERPRINT PHOTO START END END END VEHICLE ATA DISPOSITION
CORPORATION DATA CONTRACTOR# FED SERV/PROD# CORPORATION NAME
CORP-ST CORP ZIP CODE
CORP ADDRESS CORP-CITY CORP-CTY'
CONTRACTOR NUMBER
NOTES
Ne dtt WM,
-CACIUre, k.s
DODDOACID-004461

age(s)

/0
O
Referred to:
U.S. CENTRAL COMMAND 7115 SOUTH BOUNDARY BLVD ATTN: CCJ6- M MACDILL AIR FORCE BASE FLO DA 3-3621-5101 -
MS. JACQUELINE SCOTT scotti a centcom.smil.mil
(813) 827-5341/2830