Coalition Provisional Authority Forces Apprehension Form is a standard form that officials complete after the apprehension of a detainee. Form fields include, detainee name, location, time of incident, etc.
PROVISIONAL AUTHORITY FORCES APPREHENSION FORM
FIELDS MUST BE FILLED IN, IF APPLICABLE, UPON APPREHENSION
laNs)-[check one] If "Other" then describe:
Burglary or Housebreaking (I.P.C. 428) restitution (1.F?_C, 399)
!Extortion/Communicating Threats (I.P.C. 430) ults/Acts (LP. . 393-98, 402)
CI Theft (I.P.C. 439) J M. •
Destruction of Property (I.P.C. 477) A N.,
1
With Intent To Kill (I.P.C. 410) 1-10bstructing a Public Highway/Place (I.P.C. 487)
Discharging Firearm/ Explosive in City/TownNillage (I.P.C. 495) Riot or Breach of Peace (I.P.C. 495(3)) )Other
lition Forces [check one] If "Other" then describe:
Trespass on Military Installation or Facility
tI 1 1
on
ElPhotographing/Surveilling Military Installation or Facility Forces
1-10bstructing Performance of Military Mission oerty
niOtner
A C. .5crg 660 Location Grid: 113 ML lc:1 3 Li S
to 3 1
Time of Incident: Date of Report: (D/M/Y) !Time of Report:D3 ;n) / 03 01-k D hrs to 0 LOD hrs
a -3 hrs
1115 Key Connected Person: IIVictim IIWitness Last Name: Given Name7i(b)(6)
First Name: Given Name:
/Tattoos/Deformities: Hair Color.
Scars/Tattoos/Deformities:
ight: lb Height: in Eye-Color: Weight:
lb Height: in
Address:
Place of Birth:
Phone#: Ethn/Tribe/ Sex: Phone#:
DOB D/M/Y: Mobile Sect: M DOB D/MN: Mobile
license I Regular Other (specify) I1Passport F Dr. license Regular Other (specify)
Document #:
Involved
names/identifying info on reverse under "Additional Helpful Information")
Vehicle Number of Vehicle(s)
!Owner: Color: VIN: Type: Plate No.:
Number of People in Vehicle:
Names of People in Vehicle:
Vehicle:
IIWeapon Photo Taken of Suspect with Weapon/Contraband: Yes/ No I Model:
Color/Caliber:
Quantity: Make:
Receipt Provided to Owner: Yes/ No
Where Found:
Owner: ter: Email, Phone, or Contact Info:
Email:
6.2 '/ Date: as l it I 03 Unit Phone: ./*'\^ Co1, 1-- Date: / 11 /
DOD FINAL
347
DOD 57935
• V PROVISIONAL AUTHORITY FORCES APPREHENSION FORM
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contact numbers, addresses.
N reason for detention? Give names ,
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..eling (car, bus, on foot)?
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Jerson -carrying?
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e seized? a A K-91 -4
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DOD FINAL
348
DOD 57936