Sworn statement of a Soldier who treated a Captain for a hand injury he obtained when hitting a detainee. The statement does not provide details of the origin of the injury, however ACLU RDI 1158 is the sister statement from the other medic at the scene. This document relates to an AR 15-6 investigations in to alleged detainee abuse at Ramadi Palace, Iraq – July 11-12, 2003. This document is part of an investigation in to an incident related to ACLU RDI 1136 through 1171.
SWORN STATEMENT
For use of this form, see AR 19045; the proponent agency is OOCSOPS
PRIVACY ACT STATEMENT AUTHORITY: Title 10 USC Section 301; Title 5 USG Section 2951; E.O. 9397 dated November 22, 1943 ISSN). PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified. ROUTINE:USES: Your social security number is used as an additionallafternate means of identification to facilitate filing and retrieval. 4144LOSUlikt , Disclosure of your social;security number is voluntary.
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0 2. DATE OTYYMM001 3. TIME 4. FILE NUMBER
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'111111714-1T, NAME MI r LE. . qe,ADECATUS
, WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:
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10. EXHIBIT 11. INITIALS OF PERSON MAKING STATEMENT
777'
PAGE 1 OF PAGES
ADDITIONAL PAGES MUST CONTAIN THE HEADING 'STATEMENT OF TAKEN AT DATED •, 11
THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INI77ALS OF THE PERSON MAKING THE STATEMENT, AND PAGE NUMBER MUST BE BE MDICATED.
USAPA v1.00
;DA FORM 2823, JUL 72, IS OBSOLETE
DA FORM 2823, DEC 1998
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DOD 006885