Record of Claim for Compensation: Death of Iraqi Civilian

HEADQUARTERS
COMBINED JOINT TASK FORCE SEVEN
BAGHDAD, IRAQ
APO AE 09342

REPLY TO
ATTENTION OF

FCC I5G
SUBJECT: Foreign Claims Commission I5A, Claim of 1111111111111111111 04-15A-T040
HiHa, Iraq
Dear Mali
This notice constitutes final administrative action on your claim against the United States in an unspecified amount. Your claim is for personal injury to your son who the Marines shot and detained on 16 July 2003.
66‘

Foreign Claims Commission (FCC) 15A has investigated and considered the claim under the Foreign Claims Act (FCA), Title 10, United States Code, Section 2734, as implemented by Army Regulation (AR) 27-20, Chapter 10. The claim is cognizable solely under the FCA as it concerns an inhabitant of Iraq. The Federal Tort Claims Act, Title 28, United States Code, Section 2680(k), is not applicable as it excludes claims arising in foreign countries. Under the FCA, a claim for death or personal injury may be allowed whether or not the negligent act complained of was made within the scope of employment.
Upon review of your claim, it appears US forces were negligent in shooting your son. In addition, he should have been released from the hospital and instead was arrested and transported to Abu Ghareb prison. The FCA provides for payments for the wrongful or negligent acts of US forces. However, at this time your claim must be denied because you are not the proper person to bring a claim. However, if your son would like to file a claim, FCC 15A will offer him $1,000 to settle. Therefore, if he would like to settle this claim, please bring him along with this letter to the office from which you received it and a time will be arranged to issue payment.
If you are dissatisfied by this action, AR 27-20 provides that you may request that the decision be reconsidered. Any such request must be forwarded to this office for FCC consideration. There is no prescribed format for such a request. However, it should describe the legal and/or factual basis for relief. Any request for reconsideration must be made, in writing, within 30 days of receipt of this letter.
The FCC's action on reconsideration is final and conclusive by law.
k6--a
Captain, U.S. Army FCC I5A

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DOD-045945

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DOD-045946

PAYMENT REPORT

TO: DFAS, DSSN: 8724 Date:
A. Payment Data:
(1)
Submitting Agency/Office: United States Army Claims Service

(2)
Office Code: I5A

(3)
Agency/Office Mailing Address: V Corps, OSJA Camp Victory, Iraq APO AE 09432

(4)
Date Claim Filed: 1 September, 2003

(5)
Claim Number(s1 04-15A-T040

(6)
Amount Claimed: $0.00

(7)
Fund Cite: 2142020 22 0204 P436099.22 4200 VIRQ F9206 S99999 APC 9609

(8)
Payee(s): - -b 6 -

,

(9)
Address: TririalVillageHilla,

(10)
SSN: N/A $1,000.00 (1 1) Payment Amount:

(12)
Type Payment: PF

(13)
For EFT Payments: ABA Routing Number:

(14)
For EFT Payment: Account Name and Number:

(15)For EFT Payment: Name and Address of financial institution:
(16)For EFT Payment: Account is (checking) (savings) (Circle appropriate account).
B. ACCEPTANCE BY CLAIMANT (Note: This form should not be signed by the claimant if another release is signed by
the claimant is attached.) I, the claimant, do hereby accept the within -stated award, compromise, or settlement as final and conclusive on my heirs, executors, administrators or assigns, and agree that said acceptance constitutes a complete release by me, my heirs, executors, administrators or assigns of any and all claims, demands, rights, and causes of action of whatsoever kind and nature, arising now or in the future from, and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries (including wrongful death), damages to property, breaches of contract or law, and any other acts or omissions, and the consequences therefore resulting, and to result, from the same subject matter that gave rise to the claim for which I or my heirs, executors, administrators, or assigns, and each of them, now have or may hereafter acquire against the United States and against the employee(s) of the Government whose acts or omissions gave rise to the claim by reason of the same subject matter. I further agree to reimburse, indemnify and hold harmless the United States, its agents, servants and employees from any and all claims or causes of action, including wrongful deaths, that arise or may arise from the acts or omissions that gave rise to the claim(s) by reason of the same subject matter.
(Claimant)
Date: ___1111
C. AGENCY CERTIFYING OFFICER:
Pursuant to authority vested in me, I certify that this Payment Report is correct and proper for payment.
FCC
(Date) (Signature Authorized Certifying Officer) Title

Date Payment Recorded in Claim Record:
A separate payment report must be completed for each claimant
Privacy Act Statement

The information is required in accordance with 31 U.S.C. 1304. The data you furnish will be used to certify your claim for payment. Failure to provide this information may result in your claim not being processed for payment.
n

DOD-045947

ACCIDENT CLAIMS FORM oLJ )S

NAME: Offignifillinarb
DATE OF ACCIDENT: \ -_2c'
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PLACE OF ACCIDENT: ek j
YEAR, MAKE & MODEL OF CAR (IF APPLICABLE):
EXPLANATION OF HOW ACCIDENT OCCURRED: \\.\:\ s

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REPORT ATTACHED:
PHOTOS ATTACHED: No
ESTIMATED COST OF (REPAIR) (MEDICAL EXPENSES):

POLICE REPORT t
COMMENTS & RECOMMENDATION OF GST PERSONNEL:
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COMPLETED FILE SHOULD BE SUBMITTED TO CPT TYSON AVERY, USMC 1 ST MEF JAG, AT BABYLON PALACE COMPOUND
DOD-045948
ea:

DEPARTMENT OF THE ARMY
GOVERNATE SUPPORT TEAM
AL HILLAH, BABYLON, IRAQ

AOCP-CA-GST 16 AUG 2003
MEMORANDUM FOR MILITARY DETENTION FACILITY, BAGHDAD
SUBJECT: RELEASE OF PRISONER
1. The family of has presented to us a requestfor his release. The enc ose elers have been provided by the family detailing the events leading u to arrest of Mr b&-y
was in fact arrested by mistake. In fact, his arrest occurred in our zone without
2. our knowledge b an MP unit. We have several-witnesses, to include from the MP unit, .
:;,
at have stated that was shot as a suspect and transferred to the 28 th CASH .,'but, subsequent inves igation las revealed that there was no basis for his arrest. For some
I reason, the individual was transferred from the military hospital as a detainee instead of being released. This letter is the result of our efforts to lo:::.atf.. . this Iraqi for two 'weeks. We, as of yet, have been able to contact you by telephor. and are thus resorting to the use of a letter.
b6''-

POC is the undersigned of the 111111 CivIOC a telephone number or the
COC of l st Battalion, Fourth crines in Al Ilillah at 4011111111, . . _ _ . .7 - ' ' . '
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1 I I I I I I I I I I I I I I I " I I lir r
•
1111 11111,
Major, U.S.M.C. Executive Officer

DOD-045949

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DOD-045950

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DOD-045951

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DOD-045952

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In the Name of Allah , the Beneficent, the Merciful
To / 13:nby1on Governorate Office
Sub. / Recommendation

We are signatures below, the selector and selected people of Annana village . We certify and support that the guard
11.111111.11111. lives in Annana village with good reputation . He hasn't any hurt in the village and he has no any relation with former Baath Party and he is a good citizen .
He works as a guard in our village and his connection is with Al Hilla
city lieutenancy . For this reason we silm below .

Wit n es s Wit n ess Soector

im111111111111

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DOD-045953

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. ___________.•.._______.__ ..... _____
In the Name of Allah , the Beneficent , the Merciful frau honk Al Hilla city centre Lieutenancy No. / Night Guards Date : / / 2003 To / Coalition Forces Centre Sub. / Support
Lfe6e-L

We certify that night guard is one of the guards of our village ( Annana ) . He is still in the employment at present time . He was. appointed due to administrative order no. 932 in 29 / 5 / 2003 . To knforming you of this matter please .
General Pilot Lieutenan of Al Hilla city centre
03 4

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HEADQUARTERS
COMBINED JOINT TASK FORCE SEVEN
BAGHDAD, IRAQ
APO AE 09342

REPLY TO
ATTENTION OF

FCC 1B5
MEMORANDUM FOR Finance Office, CPA, Baghdad, Iraq
SUBJECT: Approving Memorandum for Claim: 04-15A-T040
1. Pursuant to my authority as the Foreign Claims Commissioner (FCC IB5), I have a proved the payment of $1000 as final settlement of Foreign Claim 04-15A-T040, f Iraq.
1)
2. The payment will be made on 4 Wiat 2.0:)(1-at the Iraqi Convention Center located in Baghdad,,
Iraq.
3. The reason for payment of this claim is based on the US Forces negligent shooting and detainment of the claimant.
Captain, JA FCC IBS

r.24 Vy2;,44
DOD-045958
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UNCLASSIFIED/OFFICIAL USE ONLY

HEADQUARTERS
COMBINED JOINT TASK FORCE SEVEN
BAGHDAD, IRAQ
APO AE 09342

REPLY TO
ATTENTION OF

1/S VA) FCC I5A Claim offarpiallialrI5A-T040
ACTION

1. Facts. On 16 July 2003, the claimant's son, alligras working as a night guard in the Annana village in Al Huila. At approximately 0300, military police from an unknown unit, believed that the claimant's somwas a suspect andAiOt him. This was not the AO of the military police unit; rather it was ithat of the Marines of the 1 st Battalion of the 4th Marines. After the shooting, he was taken to 28 th CSH, treated and then detained and transported to AbuGhareeb prison. His family and 1011111111111MINIMP, the XO of the GST in Al-Hilla were ying to get him released as of 16 July 2003. ...° 06 o . y
6- .--)
2. Opinion. , the XO of the GST in Al-Hilla stated that'll... was arrested by mistake by an MP unit. He states that he was arrested as a suspect, but no reason was given as to why he was shot. stated thAt the MPs were in the z 6. 1 st of the 4th Marines area without their knowledge an a subsequent investigation oliiii ' arrest turned out to be without a valid basis.
If in fact the MPs were not supposed to be in the Marines area, then the shooting occurred due to negligence or misconduct by the MP unit. Therefore, because the FCA allows for compensation of the negligent or wrongful acts of US forces, claimant's son
iiii,.... jkille----- NI
may be compensated. However, it must be claimant, not claim ' other to fclaim. Therefore, until such time that it is determined that Mr. was
was released from Abu Gharib due to a mistake, claim cannot be paid. Documents nee ed, CID or SIGACT report.
3.
Authority. The Foreign Claims Act (10 U.S.C. § 2734) as implemented by AR 27-20, Chapter 10.

4.
Action. That the claim be paid in the amount of $1,000.

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Captain, U.S. Army FCC I5A
UNCLASSIFIED/OFFICIAL USE ONLY 1

0 0 0 4 6
DOD-045960
,Standard Form 1034 --'--..—
VOUCHER NO.
Revised October 1987
PUBLIC VOUCHER FOR PURCHASES AND
Department of the Treasury
1 TFM 4-2000

SERVICES OTHER THAN PERSONAL

U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION DATE VOUCHER PREPARED SCHEDULE NO.
DEPARTMENT OF THE ARMY
CONTRACT NUMBER AND DATE PAID BY

DFAS-IN DSSN: 8551
INDIANAPOLIS, IN 46249
REQUISITION NUMBER AND DATE

DFAS-IN
INDIANAPOLIS, IN
46249 DSSN:5570
7

'1111•11111111.111111
PAYEE'S
NAME

DATE INVOICE RECEIVED
AND 13(9 — LIADDRESS
DISCOUNT TERMS
L

PAYEE'S ACCOUNT NUMBER
SHIPPED FROM TO WEIGHT GOVERNMENT B/L NUMBER
NUMBER DATE OF ARTICLES OR SERVICES UNIT PRICE AMOUNT
QUAN-

AND DATE DELIVERY (Enter description, item number of contract or Federal supply
TITY (I )
OF ORDER OR SERVICE schedule, and other information deemed necessary) COST PER
Claim Payment
Final Payment of FCA Claim #04-15A-T040 1,000.00
(Use continuation sheet's) if necessary) (Payee must NOT use the space below) TOTAL 1,000.00

APPROVED FOR EXCHANGE RATEPAYMENT: DIFFERENCES
¦ PROVISIONAL -.. $ = $1.00
Ili COMPLETE By 2

.
. . -.....,„

•
PARTIAL
in FINAL Amount verified; correct for

¦ PROGRESS TITLE (Signature or initials)
iii ADVANCE Pursuant to authority vested in me, I certify that this voucher is correct and proper f or payment.
U— Z Certifying Officer

(Date)2 (Authorized Certifying OfficerP 2 (Title)
ACCOUNTING CLASSIFICATION

2142020 22-0204 P436099.22-4200 VIRQ F9206 S99999 APC 9609 -
Accounting Classification Verified ByIIIIIIINIIk SSG, USA, Disbursing NCOIC
b&-a.

CHECK NUMBER ON ACCOUNT OF U.S. TREASURY CHECK NUMBER ON (Name of bank) -
Da
0
Q CASH DATE PAYEE 3
O. $
1 When stated in foreign currency, insert name of currency. PER 2 If the ability to certify and authority to approve are combined in one person, one signature only is necessary; otherwise the approving officer will sign in the space provided, over his official title. 3 When a voucher is receipted in the name of a company or corporation, the name of the person writing the company or
TITLE

corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith,
Secretary," or 'Treasurer,' as the case may be.
Previous edition usable
NSN 7540-00-900-2234 The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of disbursing Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will (.0.164Apti v4. 000
hinder discharge of the payment obligation.
PRIVACY ACT STATEMENT

DOD-045961

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