Coalition Provisional Authority Forces Apprehension Form

(.) ,UUALI I IUN FKUVIIUNAL AU I HUKI I Y: t-UKIVI
YELLOW FIELDS MUST BE FILLED IN, IF APPLICABLE, UPON APPREHENSION
Offense against Civilian(s) [check one] if "Other" then describe: :
Arson (LP.C. 342)D niBurglary or Housebreaking (I.P.C. 428) =Solicitation of Fornication/Prostitution (I.P.C. 399)D 1DlExtortion/Corrrrunicating Threats (LP.C. 430) =Rape/Indecent/Sexual Assautts/Acts (LP.C. 393-98, 402) D1D'Theft (LP.C. 439) Murder (LP.C. 405)D n—IDestruction of Property (LRC. 477) -Aggravated Assault/Assault With Intent To Kill (LP.C. 410) D11Obstructing a Public Frghw ay/Place (LP.C. 487) = Mairning (LRC. 412)D 11Drscharging Firearm' Explosive in City/Tow n/Village (I.P.C. 495 =Sin-ple Assault (LP.C. 415)D r---i Rrot or Breach of Peace (I.P.C. 495(3))
—I Kidnapping (I.P.C. 421)D 1-7Other

Offense against Coalition Forces [check one] If "Other" then describe::
=Violation of Curfew 171-respass on Mlitary Installation or Facility =Illegal Possession of Weapon I-1Fhotographing/SurveilEng Military Installation or Facay —
1Assault/Attack on Coalition Forces nlObstructing Performance of !Watery Mssion =Theft of Coalition Force Property 1-10ther
ipprehending Unit: I Location Grid: Cate of Incident: (D/M/Y) Time of Incident: Date of Report: (D/NI/Y) Time of Report: IDtoD/ hrs to hrs /I*hrs
/

Eetainee #D Key Connected Person:DVictimDWitness
Last Name:D Last Name:
First Name:D Given Name:D First Name:D Given Name:
1-air ColonDScars/Tattoos/Deformities:DHair Color.DScars/Tattoos/Deformities:

Eye-Color.DWeight:DlbDHeight:DinDEye-Color.DWeight:.DlbDHeight:Din
Iddress:D Address:

Race of Birth:D Place of Birth:
Ethnirribe/DSex:DPhone#:D Ethn/Tribe/DSex:DPhone#:
sect:D1D1MDDOB D/M/Y:DID!MobileDSect:DID1MDDOB D/MN:D1D'Mobile

1DIFD 1 'RegularD 1DIFD 1D'Regula
DPassportD1DIDr. licenseD1DOther (specify)D'PassportDDr. licenseDOther (specify) Eocument #:D Document #: btal Number of Persons Involved D(list names/identifying info on reverse under "Additional Helpful Information":
7Vehicle Information Vehicle Number of Vehicle(s) •
fake:D ColonDLicense No.:D Owner
Model:D Type:DPlate No.:D Number of People in Vehicle:
leanD Names of People in Vehicle:
Contraband/Weapons in Vehicle:

Property/ContrabandD[]Weapon Photo Taken of Suspect with Weapon/Contraband: Yes/ No
.
Model: Color/Caliber. serial No.: Quantity:DIMake: Receipt Provided to Owner. Yes/ No Cther Details: 'Where Found: Owner. T"ame of Assisting Interpreter. Email, Phone, or Contact Info:
retaining Soldier's Narre Supervising Officer's
(Print): Name (Print):
Last, First M1 Last, First MI
signature: Signature: 002068
Email: Email: _9649

DOD 001027

. .011V V •••¦¦ • • • •••• • • • • 116 MI.• ft/ • `ft., WM •.I • ••• • I • ••¦ • ¦ • • • II S• • 1,••• Goo ...V • • • • • 41. sm. • • •.• • l• ••••• •••• • 1. • •¦•• • • V' •
Why was this person detained?
Who witnessed this person being detained or the reason for detention? Give names, contact numbers, addresses.
How was this person traveling (car, bus, on foot)?
Who was with this person?
What weapons was this person carrying?
What contraband was this person carrying?
What other weapons were seized?
What other information did you get from this person? D
Additional Helpful Information:

0020b
7/11:
DOD 001028