Formica Report Annex 203: Detainee Screening Report

This detainee Screening Report is a standard form letter for processing detainees taken in to custody. The detainee associated with this Screening Report is redacted. The report details a male detainee. Words "MI HOLD" are written on top.

Doc_type: 
Questionnaire
Doc_date: 
Sunday, February 1, 2004
Doc_rel_date: 
Thursday, June 29, 2006
Doc_text: 

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_R ING REPORT
ISN:411111.11k LOCAL #: 001E1
CAP TA(:1MM COMPOUND: v
I I In :21
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Name: 411111111.11 I6I
Fathers Name: &CV)
Place: G,*I f Or46.4huic. Ak.ife.g
Grand Fab. Numillimmi
Cap Unit: 7-3 AI Rzeps.
Tribe Name: rigimil
Circumstances: mnanvir *AWN fee..11.
Alias/AKA:
',OWNS44144114.0a Ifpon• fiv Loa,/ gam
DOB: 7047(i.ve 4f
Documents:
POB: 11.14044.,)
Marital Status: MK.; SO WO D
Children t eel 4 1" . wPosiEquip:
Languages: •flAiSte.

I e
Status: Form Protection 6°Extremist .
Physical anditiol: Sec M6F
Former Regime Loyalist6
Other . ¦6
,„ Wounded: Y N . .
Branch: AF
6O CG . Remarks6FWAS)
6MC Li NV [JRaak: ?Ur
Mei
Pull Unit Dag: TILER Mow Acectx-R•Poug Malik Condition: Educationi IS, A
Duty Pm: Socaml I Yrs
Intelligence: Ave + . Ave
Job: Ave6II
Mental State: ­
Statics: aftWACt
Skills:

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. I. I
Experience:
H Date:zsgtugy6Time:ile

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Job: (f44.proapc..
(Hie((Low)Org ¦M-MN At Afrhi Cooperation : 1 u 2 . 3 .
Duties: .vmtas 4244.r /-r &yes 44444 )
OBS*6(LowKnowledge: A . BU CO )
BOW List: Y . N . BOW Code,
TechnieallSpecial Training:
Source Category: AO BO CO DO
Approach:
Special Handling Requirement Codes/Notes; Ags gimogy.Dasoliorks.rIesasawro reu...1.40wrIveraamme• iioN•ver

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Special Interest Group: 11 Ethnicity: *Wye
P Al-Qaeda Y .
Nationality:. MG*16IIS (Iraqi Intel. Service).. N
R SSO 6 Y N Religion:Abu/AI -44"•.../r Pract(ON
Y bid
& Fedayeen6 N Tribe: F(. 4861.44-V
Y
N

A Home of Residence:
Foreign Fighters. 6
Y
Ansar Al-Islam 6Y . N "Sean* 31s4 /5711167,
N .
' it l Other: MAMA
Manditory Question: 10 NO DNFO
JIDC Form 4051 TEST 3 s ou
t mu sire
• "WM 203

11111 INCRINTMICIFORIMFormica Report
6
DOD JUNE 3310
DOD0571 23

Doc_nid: 
4969
Doc_type_num: 
80