Record of Capture: Coalition Provisional Authority Forces Apprehension Form

COALITION PROVISIONAL AUTHORITY FORCES APPREHENSION
FORM
0
YELLOW FIELDS MUST BE FILLED IN, IF APPLICABLE, UPON APPREHENSION
...,
I"
Offense against Civilia:i(;) [check one] If "Other" then describe:
. ,..,i ,
lArson .(1.P.C. 342)
t,'if¦-..g, 1 'Burglary or Housebreaking (I.P.C. 423)
'Solicitation of Fornication/Prosttution(I.P.C. 399)

I lExtortion/Communicating Threats (I P.C. 430)
'Rape/Indecent/Sexual Assaults/4ts41.P.C. 393-98, 402) I 'Theft (I.P.C. 439)
Murder (I.P.C. 405)

I !Destruction of Property (I.P.C. 477)
!Aggravated Assault/Assault With Intent To Kill (I.P.C. 410)

1 !Obstructing a Public Highway/Place (I.P.C. 487)Maiming (I.P.C. 412)
. I 'Discharging Firearm/ Explosive in City/TownNiilage (I.P.C. 495)'Simple Assailt (bP.C. 415)
1 'Riot or Breach of Peace (I.P.C. 495(3))
, !Kidnapping (T :C:421)

f 'Other .—.--__-.
"

Offense against Coalition Forces [check one] If "Other" then describe:
Violation of Curfew
I !Trespass on Military Installation or Facility
illegal Possession of Weapon

I 'Photographing/Surveilling Military Installation or Facility
152:1A.ssault/Attackon Coalition Forces

1 'Obstructing Performance of Military Mission
Theft of Coalition Force Property

1 'Other
Apprehending Unit: 4/ s--$q.....). 6 n . Location Grid: A.{ C, 7/ 71 7, if 9_—"J
f 3 SS -4
Date of Incident: (D/M/Y) Time of Incident:
Date of Report: (D/M/Y) Time of Report:/ / to / / hrs to hrs / /
hrs
Detainee # Key Connected Person: I IVictim I
1Withess Last Name:
Last Name:
First Name:

Given Name: First Name: Given Name: Hair Color: Scars/Tattoos/Deformities: Hair Color:
Scars/Tattoos/Deformities:
Eye-Color: 5 a I \ J VVeiaht: / 75th Height: --71 in Eye-Color:
Weight: lb licight: ill Address:
I Address:
Place of Birth

Place of Birth:
Ethn/Tribe/ Sex: Phone#: Ethn/Tribe/ Sex: Phon ,..#:
Sect: DTI m DO B.DiM/Y: I Sect:
'Mobile 1 IM DOD Dirsidy. E-jrdubile
__:IF I IRegulcr Li F ,E —1- . 1- .
1:;e.yii,,r!
r___-_, --
Passport Plot. license Other (specify)

1 'Passport I 1Dr. license jOther (specify) ; Doc: irnent #.
t Document
Total Ntiniber of f'ersons invc.slved t- (list nan-i ,::.s/identifyiivi info on raverse

"Adclition711 Helpful
. _
.
Information Vehicle 1\lurnber Vei:icl.. t ;nem

[Tvpo:
-cr of Per,r,L , i;
r,f
\;7111r.•1-...:
i
If.T:
Name of Assisting Interpreter:
Email, Phone, or Contact Info:
Detaining Soldiers
Supervising Officers Name
(Print):
Print):
Signature Signature:
Email:
Unit. Phone: PAA (r. "2„, Li Date - I /. / 11 / O Z I !nit Phrino- rlotn•
DOD FINAL 369

DOD 57957

COALITION PROVISIONAL AUTHORITY FORCES APPREHENSION FORM
0C
Why was this person detained? Ai.
•.&
Who witnessed-this person being detained or the reason for detention? Give names, contact numbers, addresses.
How was this person traveling (car, bus, on foot)?
Who was with this person?
What weapons was this person cafrying?
.
What cent; ai'end was this p:r3Cn carrymg (
'¦:"..voat othcr V:TF?CliS WL::e sei•Led?
yvAl ,
jr:t

DOD FINAL 370
DOD 57958