Formica Report Annex 40: CID Report: 0233-03-CID259-61217

c ‘
AGENT'S INVESTIGATION REPORT

40--..).
RD/NUMBER
0233-03-CID259-612!T

CID Regulation t95- I
PAGE 1 OF s PAGp__
Dam's
BASIS FOR INVESTIGATION: About 1010, 2 Nov 03, this office was
y the le Military Police Battalion (CID), Baghdad Internationa:
(BIAP), Baghdad, Iraq, who indicated a service member died after ni
obility Multi-purpose Wheeled Vehicle (HMMWV) ran over an unknown
xplosive device.

out 1100, 2 Nov 03, 11111110.coordinated with 111.11.
, Assistant S-3, Battle CPT, 2/3 Field Artillery (FA) 80:-L.:
(BN), (Baghdad, Iraq), Giessen, Germany, APO AE 09045, who relateC

, dIMMIIINI, 2/3 FA BN, (Baghdad, Irag), Giessn:, ermany, APO AE 09045 (NFI), was killed when his HMMWV ran over a xplosive device believed to be either a improvised explosive • r a land mine. related about 2327, 1 Nov 03, person , nknown were driving a black 4-door, hatchback "Passat", when pers:= . nknown fired two rocket propelled grenades (RPG)'s at.the 2/3 FA RN;
•
Forward Operating Base (FOB), located at grid ./Milr. The I fled the area. A vehicle mounted Quick Reaction Force (ORF) exited FOB and gave Chase to the black "Passat". The QRF fired a squad yeapon (SAW) at the vehicle; however, it was unknown if the vehici struck. The QRF was unable to sto the vehicle, which subseguenz:y
soaped. The QRF was near the , Baghdad, Iraq, (gr:
40339284) when it. prepared to return to the POS. 0111111MMIla HMV.'
entered soft dirt on the side of the road and struck an unknown excl.

evice believed to be an IED or land mine. The HMMWV was able to
to the FOB. 4111111111MINI sustained shrapnel wounds to his face, arrr
torso, and was evacuated to the 2/3 FA BN Aid Station, where he

edical treatment by , Physician

ssistant, 2/3 FA BN. was further air-evacuated to t?,,.
ombat Support Hospital (CSH), Baghdad, lraq, where he was prons,;.?.
t 0325, 2 Nov 03.

ENT's COMMENT: 41111111amme was unable to determine if the SA
IED and the vehicle borne RPG attack were related.

bout 1115, 2 Nov 03, 11.11.1. interviewed 1.1111.111111111Pwho stated
Physician Asaistant for the 2/3 FA BN, and performed medical zreJ­pon arrival at the Battalion Aid Station. 46.1.111•11111
further stated he performed a surgical stracheotomy and subsequen-

7YPED AGENI'S NAME AND SEQUENCE NUMBER ORGANIZATION
12" MP DET ;CID), BAGHDAD IRAC

•
DATE EXHI131T 11 Dec 03
CID FORM 94 FOR OFFICIAL USE ONLY

I PE1377

2893
DOD JUNE
Acaurrs INVESTIGATION REPORT
Rot NUMBER 0233-03-MD259-61217 CID Reguiahort 1 95-1
PAGE 2 OF 5 PAGES
mffmis
intravenous fluid therapy prior to elMilla being air-evacuated to the

28" CSH.

Quiiitim;33C, 2 Nov 03, MIMI! coordinated with

, 2/3 BN Executive Officer, (Baghdad, Iraq), Giessen, Germany, who related a 15-6 Investigation was going to be conducted regarding this 'ncident. 411IMINIO further related he inSpected the damaged HMMWV and
totted there was shrapnel damage to the heater core, floorboards, exterior ody, tires, and doors.4101111111111,was going to expose photographs of the MMWv and forward them to the appointed 15-6 Officer. amprome did not eve a cost estimate regarding the physical damage to the HMMWV.
rkbout 1500, 4 Nov 03, WIIMMUI/coordinated with Affairs, 54th Quartermaster Company, (Baghdad, Iraq), Ft Lee, VA 23801, who provided a copy of DA Form 3894, which indicated LTC
28th CSH, Neurosurgery Attending, pronouncedaNIIIMIIM eceased at 0350, 2 Nov 03. The listed condition directly leading to eath was attributed to "Penetrating Brain injury). (See DA Form 38941
• 'About 1510, 17 Nov 03, 111111.11111 coordinated with 'chief, Administrative Law Division, BIAP, Baghdad, Iraq, who provided a
opy of the completed Army Regulation (AR) 15-6 Investigation pertainingrto the death of 411111111111111•111. (See 15-6 Investigation for details)
'About 1130, 4 Dec 03, 411111111111, ISNINNINNINININNIIIR 5684, and 4111•11111pw 6094, this office, coordinated withIMIIIIIIIMIMIIIIII•1MillIll1111111N1111P , S-2, 2/3" FA, who stated he previously interviewed current bodyguard for the Ministry Interior, and who was a former Iraqi Police Detective.
. Both of the aforementioned individuals reside in
ection #314, Baghdad, Iraq, and are in a cell in 011111111111111kesponsible
for attacking Coalition Forces.

GENT'S CC)MMENT:

TYPO AGENT'q E AND SEQUENCE NUMBER ORGANIZATION
12" mP DET tCIO), BAGHDAD IRAO
T RE DATE 1EXHUNT

II Dec 03

CID FO M 94 FOR OFFICIAL USE ONLY

'ma77

•

UNCLASSIFIEW11101,110 Rank* Ripon -Annex 40
•.
DOD JUNE 2 89 4
•
6$3

AGENT'S INVESTIGATION REPORT
RO1 NUMBER

0233-03-C1D2S9-61217

-. CID Regulation in-;
PAGE 3 OF 5 PAGES
Lmu
responsible for ihe death of 111111/111111MF. 11111111..111111111111 stated
revious intelligence had appeared to be truthful; however not always able
be verified for accuracy.

'GENT'S COMMENT: Prior to leaving, illommimp stated the estimated cost
lc! damage to the HMMWV was $2,000.

bout 1030, 8 Dec 03, Aliiiii, interviewedallIMINNIMMIIIMMINIIIIIIIIIMIP KA: 11111111mmem, currently residing at C Battery, 2/3ed Field rtillery, Baghdad, Iraq. 41111111111111Mcurrently worked as a bodyguard for
the Iraqi Ministry of Interior, which was based at C Battery, 2/3ed Field

rtillery, and further provided intelligence to the C Battery regarding
the death of coalition forces. OMMilimm, was previously a Detective for
the Iraqi Police and when coalition forces occupied Iraq, he offered his
services to the U.S. Army. ONOMOMMONILwas residing with C Battery due to
che numerous death threats against him and his family. 411111MONMONIP

wt.4 6-)
. Subsequently his house was
destroyed by erson(s) unknown. zs. Forces have informed inquiring
Iraqis that was killed by person(s) unknown.

hrough the use of an interpreter, related in early Nov 03, h

41111.froraS iti)(%) %MC,
who was believed to be a member of the Fedaheen, located lin the surrounding area, and was further believed to be reeponsible for ithe death of coalition forces in Iraq. The following day011.111111111MINV 'located...NW who was sitting in his 'white colored ambulance, next to
restaurant and a mosque. asimign approachedamilms* and introduced I;.imself as "Mustafa" and told him chat he currently worked foreeniNgp .11.111.0.11011011. requestedIONOMMOMPhelp in the fight against
Americans. ONIONIMPF stated if it involved hurting the Americana, he could help with weapons and show the locations that the Americans "come and go." Mr.dillirrequesteddigliiii get in 4111.1111111111111111•13 vehicle with him and his four friends, and leave the area. applaMMUMPagreed and entered Mr.
41111111111.vehicle. While traveling within the Baghdad area, P4r.41111111P
stated he could provide Rocket Propelled Grenades (RPG) aria Bazookas. Mr.
MO then asked why they wanted to use RPG's, and that they should use

• ..-
I TYPED AGENT'S NAME AND SEQUENCE NUMBER ORGANIZATION
annillitili, 5731 12" RP °ET (C10), SAGRDAD IRAQ

DATE lERHUSIT
11 Dec 03

Wisp
CID FORM 94 FOR OFFICIAL USE ONLY
t FM 7?
UNCIASSIFIENFOU0 RCM* ROW! Part 40
7771!11111
,MMIMIMMIMP
DOD JUNE 2 89 5
• /36

3
AGENDS INVESTIGATION REPORT
kOINUMBER

0233-03-CID259-6121T

CID Regukulon 10.1
PAGE 4 OF 5 PAGES

DETA44.4
Improvised Explosive Devices IIED). stated he could take them to
a man named INSNimiNip, who would provide both the IED and the remote evice, 11111.11111111111P was aware that diallefaer was currently detained at C attery, 2/3'd Field Artillery.) 41111.01111irdrove through numerous back
roads and alleys until he arrived at the front gate of C Battery, 2/3n1
Field Artillery. 1111=1111111, asked him what they were doing there, Mr.
then stated "Let me introduce myself, my name is HOhamad ammar-
knew ofl1=1111111111111111Pby name and exclaimed "I got caught." wir

then stated he was recently engaged to an Iraqi woman and would do nything to not go to prison. Upon returning to C Battery, Mr. SADDAM was sked bya111.111111 to find out LAMMED knew anything regarding the eath of an American Soldier within the last few days. 411111111111Pinformed
thatd1111.111111ar provided an IED todillimsammiNerwir anddll¦MINImanimiri¦momio., who subsequently
•
laced the TED and detonated it as a High Mobility Multi Purpose Wheeled
;Vehicle (HMMWV) passed by. 01011.11. described the incident as being
!consistent with the time and place of the death ofel.111111111M

rANNIONR informed this office that4MOMPIPwas further interviewed at
rn unknown location and believediMMOMMW was released for' unknown
reasons.

6,40 IA 10
AGENT'S COMM: MIRMINNINIP previously provided 01111MMINIMPIPIMMIMP 1111111MMEMEMNIONIMONINIIMINEMNP regarding the aforementioned information. About 0930, 9 Dec 03, IIIIIIMMNPbriefedIIIPIIIIIIIPNIPIPIIIIIIIIIIIR Federal Bureau of
investigation, Baghdad, Iraq, on this investigation. 1111111111111111111111111irstated e would research the database of his agency and determine if the forementioned names are currently/previously being investigated.
lha

bout 1230, 11 Dec 03, 011111/01111M.1111.111111111111111•1P, 6094, interviewed CPT
, who verified he was previously provided information by Mr. allallo
regarding the death of affilMIRMI/agmml/Nen believed mr.ommiliPwas
00/...,rauthful re

i...-thraallailIMMIONM1110111.1.1.1011111R 01111MONNOOP further stated he tested the validity of the information on numerous occasions and information always proved truthful.
arc
TYPED AGENT'S N -SEQUENCE NUMBER ORGANIZATION
12u HP DET (CID), BAGHDAD IRAQ

1

DATE 1EXHONT

,
II Dec 03

RM 94 FOR OFFICIAL USE ONLY
I FEB 77
UNCIAANIFIEDMFOU0
PorrniasRopoit-Annec40 ... _
,,,111 *lk,.
• .--::::.'
DOD JUNE 2 89 6

AGENT'S JAVESTIGATION REPORT
1
R.-AA:WA:EA
0233-03-0D259-61217

I

PAGE 5 OF 5 PAGES
MU:,

AGENT-5 COMMENT:

MOMMOMMOSI was aware of the current safety status of Mr.
1111111,anJ his family.///LAST ENTRY///

11-17,E0 AGENT'S NAME AHD SEQUENCE NUMBER ORGANIZATION
LZ" MP OET (CID), BAGHDAD IRAQ

•
DATE EXHIBIT
11 Dee 03

IIIIIIIIIIIIIIIIIIr
CID FORM 94 FOR OFFICIAL USE ONLY
1 FEB 77

UNCLASSIFMFOU0
Pamlico Repot -Annex 40
DOD JUNE 2897
7 3

AGErril INVESTIGATION REPORT
imiNumnA
0233-03-0D259-6;217
..ID gegtaatson I 95-1
F!AGE 1 OF PAGES
armu
our :300, 29 Dec 03, 1.11.111.111111111111111111P, and interviewed Intelligence Officer (S2) 2/3 FA, who stated
,sheir unit apprehended.1.1111.11.1111.111¦11.11111 1111•111101111111.1
nd4INIMINIMMININNAWNIMMII~j1111~1INVIIIIIN stated the forementioned individuals are related. dili•1111111110111111111111111111 stated intelligence was being developed linking them to at least three homicides f US Army personnel within the Zone 18; (investigations currently being
investigated by this office). The aforementioned detainees were currently eing interrogated by US Army Military Intelligence and would eventually e transferred to Abu Ghraib Prison for further interviewing.
out 0900, 9 Jan a4,11111imlInammewomisw anaNNINIONNOSIMM
, 5876, this office re-interviewedIMPINIIIMMINPand0111•11111111.NiNNW ho provided sworn statements implicating numerous suspects in the death f three US Army personnel. (See sworn statements for details)
'About 12:0, 12 Jan 04,411141Wcontacted this office from the Abu Ghraib
•
1Prison, and related the following National Detention Registry System .NORs) detainee information:
' 1. •011111111=m11111111. #156282
2. iMOMMUMMMP #156283
3. aggemrlir #156216
4. AMMOMOMMMOP • 1156244
5. 4111111111111.1.11111111111111P $156244
MUST ENTRY///

3

•4

,

TYPED AGENT'S NAME AND ..!,::—,!;-
4101IMMONMEMOMMWOMP (CIO), BAGHDAD MAO

M?.

licouerr
•i%Ta•
:AX 04

CID FORM 94 FOR OFFICIAL USE ONLY
I FEB 7 7
.
•
(4 Repot -.Annex

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. . . . •
289 8
DOD JUNE
•
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SWOFtN STATiZIA 1o• For use of Ows form. me AR 190.41; 4,;,..ALSoiltD 25 - 612 1 7
PRIVACY ACT STATEMENT
AueivoRITY:
Tide 10 WIC Section 301: Title 5 USC SlIstion 2151: 1,0, 9327 dew Neveineer 22, i 943 0.9NL
PRINCIPAL PURPOSE:
To provide commanders and taw enfomenwrit officials with moan* by which information awe be occermeteROUTINE USES: YOuf essiN security swrobm br used as an DWElionsuelternow MINIM of iderwification to facilitate fling one retrieve.ONICLOIPJFIE: Disclosure of your social *sterile numbs, is voluntary.
t. LacAnot4
2. OATE Mi'VAIA4001 It nue i 4. FILE MAWR
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7. GRADS/STATUS KOORESS
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08SOLEEE. gum .11 OE
mwisimousi rweiritis -"mow 40
DOD056715
DOD JUNE
2899
11111- n -c/?5 niati
SWORN STATEMEIVT
For usa at ilia tam, lea AR 19045; the proponent agency id 00CSOPS
PRIVACY ACT STATEMENT AUTHORITY; Title 10 USC Seeders 301; Tive 5 IJSC Scotian 2151; E.O. 9397 doted November 22, 1943 /WM. PRINCIPAL PURPOSE; To provide eommanders and law enlacement officials with means by which information may be accurately ROUTINE USES: Your social sitCurieY number is used as an additionsliehernata means of identification to ?wiliest* WI aid reviews. DISCLOSURE-. Disclosure of row social seouriry number is volt/mew.
12. DATE irFYYMMOOI 13. TIME 4. FRI NUMIIIR 1.141‘ vzq.
ORAOUSTArus
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ENE OoTToM OF EACH ADOITIOArAL PAGE muST REAR THE INITIALS OF THE PERSON MAKING THE STATEMENT. AND PAGE mAuGER ArtIST BF BE INDICATED.
DA FORM 2823. DEC 1998 OA FORM 7-823. JUL 77. IS 0880tE 'NI"' VI •P:
..4111maimpir-7-Formice Roped Annex 40
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DOD JUNE 2 9 0 0
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Formica Ripped - Annex 40
DOD JUNE 2 9 0 1

DOD056717

a)).-1 136

et•
•¦••
023S- OS -cID259-6121/
SWORN STATEMENT
For use a this form. ass AR 190•45; the rammartmg agency is 000301,9

PRNACY ACT STATEMENT
AUTRONTT
ink 10 USC Section 301; Trek 5 USC &moan 21151; E O. 9397 peed Naveinber 22. 1143
/SSW
PRINCIPAL PURPOSE:
re provide commanders and law onfwawnent officials Mtn means by which biOnnonion may be isseennely
ROUTINE USES:
yaw midi mucky number 1E mad as en addliionaUaltemata moans of 101,10Staion 10:9:1:01tdu.1:111tatriavar.
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womat, cAlIED 111111111111111.iS wiviN6 A CAR S rAigS./
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INITIALS OF PERSON MAXIMO STATEMENT
•
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TAKEH AT.OA mu THE DOT :Om Or EACH AOOITioHM. PAGE MUST sem THE mmTIALS Of THE PERSON AMMHO THE STArtmEmr. AND PACE MAWR
Anal.figOICA TEA
OA FORM 2823, DEC 1998
DA FORM 3923, JUL 7?, is oPSCA.ETE
Fein** RePort - Annex 40
-
;
,
DOD JUNE 2 9 02

DOD056718

6-1 g

SWORN STATEMENT
For men! W. form, Ise AA 19045: la• proponent etoncT 10100CSOPS

Act Act stAtEmovrti 9 e 03 -c 1 D 2 b 9 -S
'UM.
Tight 10 USC Section 301; Tido 5 USC Section 295 t: E.O. inn tad Novanstrel 12. 0143
AUTHORITY-
hem% Os• *Aids inhumation May 6* occueateh itanafied. PIWICIPAL AURPOSe:
To oto•irai cormolollett snit snhecelnent
Tow 'pole, Pawky numbot lamed Rs SA edeetIoneUelsernett means al idontiScation to laciatata hem and hulhes. USf5. •
4. FILE Numwo Oioclosute of yaw social secutitY number is velan:".
DISCLOSURE:
frYY1V.r.tapj 13. TIME
2 DATE
1 LOCATION
7. oAADErSt ATVS
FST7
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DOD056719

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FULL

2904
DOD JUNE