Formica Report Annex 74: Statement of Soldier

Sworn statement. Contents entirely redacted.

Doc_type: 
Interview
Doc_date: 
Tuesday, June 15, 2004
Doc_rel_date: 
Thursday, June 29, 2006
Doc_text: 

SWORN STATEMENT
For use of tide loon, see AR 100-41: tin papaw, agency is =SOPS
MACY ACT STATEMENT
• AUTHORITY: Tide 10 USC %Mon DOI; Title 6 USC Section 2651; E.O. 9397 dated Nevantber 22. 1243 ISMS. IMINCIFAL FUMES: To e¦ ftede aorereanders and law mown min efOcirds with mans by whish it kweetion may be Wgillitatf ROUTINE WlSt Your social eecurity numbs is used aa an adddatialfelternses means of Identification to fact tats Etna and retrieval.
Dimicess of yew acrid security number Is IraisssY•
DCATION 2. DATE fVYYVAIMOU

3. TIME 4. RI.E NUMBER
.Pk‹.7. IOW 1-6• (Faml i4.raid lowo 4(r. r-sq'-­
NAME

7 "47/5 436 2)
W Af A? rT).% et 410 A. 11.-.7 (NG v A4340411 ,214C7
1111101111111111111111t . WANT TO SAME THE FOLLOWS; STATEMENT USW OATH:
O. WSW I 1 1. ALS STATEMENT
PAGE I OF

AOOMONAL PAGES MUST COWAN T E HEADPitt •STA71FMVIT TAM AT - DAM
TIME lOTTOM OF EACH ADDMONAL PAGE warWAR THE INTIALS OF THE PERSON MASONS THE STATEMENT, AND PAGE MINNS
417 SEMICA TED.
MA 2823. DEC 1988 DA FORM 2223, JUL 72. MONEOLETE

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DOD JUNE
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DOD056813

YK TNM PAGE IF MEDIC. I nis PAM NI NOT mom MASI MO= 161111AL PAGE or TM FOIL Afoilft4C
STATVAINT ofONO TAKEN AT I8C r00136 DATED
S. STATEMENT
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INITIALS OF PERSON MARINO STATEMENT
42 OF 3 PAGES
PAGE

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Loa FORM 21124 ism

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Formica Report -Annex 74
DOD JUNE 2998
DOD056814


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STATOOST OF TAKEN AT 1:13CrliAtabC, DATED

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AFFIDAVIT HAVE READ OA HAVE HAD NEM TO ME THIS STATEMENT

WHICH NS ON /.
Y UNDIRITAM3 THE CONTENTS OF THE ENTINE STATEMENT MADE SY ME. 1111 STATEMENT IS TRUE. I HAVE *MALEC ALL CORRECTIONS AND HAVE WITIALED THE SOTTOM Of EACH PAGE CONTAINING THE STATEMENT. I HAVE MACE THIS STATEMENT FREELY THREAT OF PUNISHMENT, AND WITHOUT COERCION, UNLAWFIA.INFLUIFICE.
• : WITNESS Subscribed and sworn before rae. amson eullwited by lar wintl thIs day of j54Ulte . JOOY
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ORGANIZATION ON ADDRESS
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ORGANIZATION OR ADDRESS fAutsseeky T. Atiosebbow Q.
INITIALS OP PERSON MAKING STATEMENT FADE o PAGES 3, OA MINItan bee NM 1011/A111.00

DOD JUNE 2999
DOD056815

Doc_nid: 
4851
Doc_type_num: 
73