When interrogator left the interrogation room for a few minutes, Special Forces members had entered the room and were blowing smoke on detainee when interrogator returned to the room. Detainee states that others touched his hands with an electrical device.
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SWORN STATEMENT
For use of this form, see AR 190-45; the proponent agency is ODCSOPS
LOCATION
I DATE TIME FILE NUMBER 61--CB 2_ LAST NAME, FIRST NAME. MIDDLE NAME
SOCIAL SECURITY NUMBER GRADE/STATUS
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EXHIBIT
ON MAKING STATEMENT
_±PAGE 1 OF PAGES
ADDITIONAL PAGES MUST CONTAIN THE HEADI
ATEMENT OF TAKEN AT___ DATED CONTINUED." THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT AND BE INITIALED AS "PAGE OF PAGES." WHEN ADDITIONAL PAGES ARE UTILIZED, THE BACK OF PAGE 1 WILL BE LINED OUT, AND THE STATEMENT WILL BE CONCLUDED ON THE REVERSE SIDE OF ANOTHER COPY OF THIS FORM.
DA FORM 2823, JUL 72 SUPERSEDES DA FORM 2823, 1 JAN 68, WHICH WILL BE USED. USAPPC V2,00
020563
DOD-043628
STATEMENT (Continued)
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AFFIDAVIT
, HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT WHICH BEGINS ON PAGE 1 AND ENDS ON PAGE . I FULLY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE
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2 BY ME. THE STATEMENT IS TRUE. I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT. I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD, WITHOUT THREAT OF PUNISHMENT, AND WITHOUT COERCION, UNLAWFUL INFLUENC
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WITNE.• Subscribed and sworn, before me, son authorizeci.j822
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ORGANIZATION OR ADDRESS (Authority To Administer Oaths)
INITIALS OF PERSON MAKING STATEMEN
PAGE OF a._ PAGES
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DOD-043629