Record of Capture: Coalition Provisional Authority Forces Apprehension Form

COALITION PROVISIONAL AUTHORITY FORCES APPREHENSION FORM
YELLOW FIELDS MUST BE FILLED IN, IF APPLICABLE, UPQN APPREHENSION
Offense against CiviliFr(s) [check one] If "Other"
Arson (I.P.C. 342) Solicitation of Fomication/ProVution(1,P.0 399) ID!Rape/Indecent/Sexual Assaults/Ats:s(1.P.C. 393-98.402) Murder (I.P.C. 405) IDlAggravated Assault/Assault With Intent To Kill (I.P.C. 410) ? .:
ID!Maiming (I.R.C. 412)D Simple AssailIt (-P.C. 415) Kidnappinglf.P.Z. 421)

then describe:
ID!Burglar; or Housebreaking (I.P.0D428)
1DlExtortion/Communicating Threats (I.P.C. 430)
ID!Theft (I.P.C. 439)
ID!Destruction of Property (I.P.C. 477)
1D!Obstructing a Public Highway/Place (I.P.C. 487)
Discharging Firearm/ Explosive in City/TownNillage (I.P.0 495)
Riot or Breach of Peace (I.P.C. 495(3))
Other
.

Offense against Coalition Forces [check one] If "Other" then describe:
Violation of Curfew I !Trespass on Military Installation or Facility
1D!Illegal Possession of Weapon Photographing/Surveilling Military Installation or Facility IlAssault/Attack on Coalition Forces I !Obstructing Performance of Military Mission 1---','DITheft of.Coatition Force Property Other
Apprehending Unit: ,4kr6(.4 S,--1,D6 n,m8 ezial I Location Grid: .3 6 5DtAc.-71 r 3 go
Date of Incident: (D/M/Y)
lb,/ . )3//03 to (7 / kri)/ 0---;
Detainee #

LastIName:
First Name:
Hair-Color:

Eye-Color: a '
Address:
Place of Birth:

Ethn/Tribe/ Sex:
Sect:

I
Time of Incident: Date of Report: (D/M/Y) Time of Report
ego hrs toDhrs t (' / Nol( / e)-hrs
Given Name: Scars/Tattoos/Deformities:
Weight:D1St) lbDHeight:D----c, in
Phone#: M DOEL-WM/Y: ! Mobile
D1 -1F Regular
,DPassport Dr. license Other (specify)
Document #:

FrotalVNumber of Persons InvolvedD11D(list nameshcle.ntifying info•on reverse under "Additional Helpful Information")
........

---_--=—. -----:D— ______
D
—1
liq,/jkfehicle Inforrnz-itionDVehicle NumberDof Vehicle(s)D'Owner:D
Make: Color:D(VIN:D

i 9.Model: Type: D•DIPIcte No.:D Number of People in Vehicle :
i
iDYear: Names of People in Vehicle: ;DCentiabrInd,1Vezipcir; in Vehicle:
— --..-.-z--;-...............-r-,

-7.---.­
1---1.,
•DiDi:-rotyz,:ryCont7land ILY-. Weapon Photo Taken of Suspect with We_apon/Contiabancl: sr. c:.;/ 113
'.--D Model• 13DI riiE.I;e:
Naive of Assisting interpreter: D

(r24
Detaining Soldie
Print):

Si• nature:
Email:
Unit Phone: Fi¦A tro_, 4 Date

DOD FINAL
Key Connected Person: Victim !D!Witness
Last Name:
First Name:D Given Name:

Hair Color:
Eye-Color: Address: Place of Birth:
Ethn/Tribe/ Sex: Sect:
Passport
Document #:
Scars/Tattoos/Deformities:

Weight:DlbDHeight:Din
Phone#: M DOB D/M/Y: IDMobile F IReaular
Dr. license I Other (specify)

[Color/Calle::
IP.cceipt ProviAd to 11,.' Owner:
Email, Phone, or Contact Info:

F66 f3coN ,
Supervising Officer's Name
Print

Email:
Unit Phone: Date:

360

DOD 57948

COALITION PROVISIONAL AUTHORITY FORCES APPREHENSION FORM

Why was this person detain?'= (1=1--0
-1--

• Who witnessed this person being de/ained or the reason D7 • contact numbers, addresses. e‘crk.‘__17/9-vt-c pr
How was this person traveling (car, bus, on foot)?
in_
Who was with this person?
What weapons wa is person car ' g?
h
What contraband was this person carrying? DiJOA_R-_,­
What other weapcns were seized? D
What other information did you get from this perS01":.
1 I, -1

07.D
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,TC.;;;;. •.;
A
_. ,
"YTS.::

DOD FINAL 361
DOD 57949