This is a U.S. Army Foreign Claims form for monetary compensation. The claimant is an Iraqi citizen whose father was arrested in Iraq by U.S. forces, taken to Abu Ghraib prison and died while in custody. He claims that the body of his father was recovered from a local police station and had evidence of abuse and maltreatment.
Claims Form
To: United States Arm Claims Commission. From: Name: k6 Address:
I am
a. A citizen and national of: 1
resident of: 1
b. A
. permanent
c.
Employed by: 1
d.
Check one ( ) An insurer ( ) Not an insurer
e.
Check one ( ) An subrogee ( ) Not an subrogee
I hereby make a claim against the United States Government for damagPv injuries caused by: (Name, Organization, Military Department. Address. TPirmhone
jOrcr.")v,
The property damaged is owned by: (If the claim is made as an agent, parent, or guardian, attach a power of attorney or other evidence of authority and fill in the form below for party sustaining the damage or injuries.)
My claim arose at: A,170k00,) f (Town vo.A. (City) (Count 1
My claim arose on: Menu: Day Year
Give a brief statement of the accident or incident on which the claim for damages to property or for personal injury is based. (Use back of this sheet if necessary.)
J.
iAlr7l1,tel1-e-4/) 1
f )4" 1 s tl111
4'
4
ael_: r—e--z-7-7-A 11-e
CjuL 3 4 9
DOD-045963
•
Describe nature and extent of property damage or personal injury sustained as a
result of the above incident.
prejbiel
List in detail 'the amount of property damage and itemized expenses resulting
from the property damage or personal injury: (Attach bills and receipts, if
applicable.)
1
Item Amount
• rob eiS
NO AIM, •••••
To tal:de2AC7022Czct___2j:::j
I was insured to the following extent against the damage or injuries I have
sustained:
The name and address of my insurer (if any) is:
1
(Name) (Address)
I claim as riarnaFes: Inclicate amount in L.S. dollars and locai local 1_fp 6:42c2, Air ir
1eyr l
(Signature of Claimant)
Subscribed before me this1day of , 200
• (Print Name)
(Signature)
000350
DOD-045964
To: CPA,Esq..
Sub: Compensation
I'm the father of the demise " in may, 2003 the Americana forces arrested my son and prisoned him in Abu Gherab- prison for five months and we were told by some of individuals who were with him in a prison.
On 8-11-2003 the corpse had been founded and put into a black sack, wearing ared uniform on which there is a number (84).
He was found with hands that being shuckled according to the order issued from the hospital to AL Shua'a police station. After that it had been called upon us for receiving the cropse. The messers,Esq.
The official orders issued from Iraq police station, the specialized court along with other documents like demise certificate certify that the cropse had been placed at the entrance of the hospital by. American forces. These documents are official and right one. So I beseach you to compensate me financially due to the my son death and I'm ready to provide you with the copy of these orders.
With best regards
The father of the demise
01111111/111111/11111111
Baghdad- Dayala Bridge
1111FAMMINIMINIMII"
00035j
•
5 4 pet;cc_ s4-4/0•1:g—II— 2=,c7_
were_ Cr, (S Joy fiv.. ‘4.444‘11 I-61-64_ evemnrcan S911,L).-4-a body agioci-V--aiddkle_J-car
vA6144Ad kospet‘vi_dPocAue-idbooty
OF 44 map( hisfat:b6e ic haqde_ex-ti4
V10
vtot- ide)ti t-efy .14E \90dy+-Aare war /D 65v,
DOD-045966
5 11 Act pc.lfcc 51-4c41"a tie 2-e,eR
epori-asA-ody
)204' J nr -Lek Va) \etetArif trrei
dys
cf.
Tic=7.-,
ve44te vy_ei 04e_
h It rpo &coik &let
2.,
DOD-045967
CLAIMS CHR ET
CLAIMANT'S NAME: FILE # 1 C-1(D4-\ 9364-
AMOUNT CLAIMED: S
DATE OF INCIDENT: .9,/ 6) 4.4%... 04-f
DATE CLAIM FILED: 1
DATE SUSPENSE RECEIVED DATE
-
O LI 1) F40(4
.34z-coa_ ar-7 _
ISS N
•
r•-Y" +r, LAtr, l(m-x--:c.0D.F,
000354