COMMANDER'S REPORT OF APO AE 09375

N

COMMANDER'S REPORT OF 1'''CIPLINARY OR ADMINISTRATIVE ACT, For use of this form, see A 10-45; the proponent agency is ODCSOPS ,...,L . / • c-

SUSPENSE DATE IYYYYMMDDI

2003/06/10

PRIVACY ACT STATEMENT

AUTHORITY: Title 10 USC Section 301; Title 5 USC Section 2951; E.O. 9397 dated November 22, 1943 (SSN).

PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately

ROUTINE USES: Your social security number is used as an additional/alternate means of identification to facilitate filing and retrieval.

DISCLOSURE: Disclosure of your social security number is voluntary.

1. THRU CDR, 800th MP BDE Camp Arifian, Kuwair APO AE 09366

2. TO 10th MP DET (CID) K' (,) -2 Camp Bucca, Iraq .---) ..„,) "--- APO AE 09375

3. FROM CDR, 724th MP BN Camp Bucca, Iraq APO AE 09375

4. USACRC CONTROL NUMBER 5. MP REPORT NUMBER

093 -10 --C IDS/f ^ r.takA. CA

6. SUB-INSTALLATION IDENTIFIER Camp Bucca, Iraq

To be completed by the commander or supery sor of the subject identified below and in corresponding MP/CID report. Check all applicable blocks. Briefly explain circumstances not covered by blocks. For multiple offenses resulting in more than one type of action taken or action taken for offenses not listed in the report, explain in block 15, Remarks, which offenses apply to blocks checked and action taken for other offenses. Retain last copy and return all others to addressee indicated in "TO" block on completion of final action.

7. NAME OF SUBJECT (Last, First, MI)

iiii~40i<44)-$

8. GRADE E-3

9. SSN 101(-4 KerSe-10. DATE OF BIRTH (YYYYMMDDI

eariNOM lolc:.5-6(6.5 ) 11 a. OFFENSE(s) 11b. DATE OF OFFENSE(s)

1. Failure to Obey Order (Art 34 UCMJ) 2003/05/12

2. Reckless Endangerment (Art 92 UCMJ) 2003/05/12

12

X

* Subject correction,

ACTION TAKEN a. * NONE I 1(1) INSUFFICIENT EVIDENCE (2) OTHER (Explain in Remarks)

was advised that although no action was taken, the report would be retained in Army records and that requests for amendment,

or expungement may be submitted IAW AR 190-45 (MP Reports) or AR 195-2 (CID Reports).

b. ADMINISTRATIVE

REFERRED TO (Check appropriate blocks) DATE REFERRED (YYYYMMDD) DATE RESPONDED (YYYYMMDD)

c.

d.

F = FAMILY ADVOCACY

D = DRUG/ALCOHOL ABUSE .

S = SPECIAL REFERRAL

E = EQUAL OPPORTUNITY

L = LEGAL OFFICE

M = MENTAL HEALTH

R = RELIEF AGENCY

—

_

—

_

NONJUDICIAL

JUDICIAL

(Article 15, UCMJI

COMPANY GRADE

GCM AUTHORITY (If subject was tried by court-martial

SUMMARY COURT MARTIAL

SPECIAL COURT-MARTIAL

_

—

_

_

FIELD GRADE SUMMARIZED

GENERAL OFFICER attach a copy of the court-martial order giving findings and sentences.)

GENERAL COURT-MARTIAL

CIVIL COURT

13. JUDICIAL

_

FINDINGS

GUILTY

NOT GUILTY

_

_ DISMISSED

OTHER (For example, guilty of a lesser included offense. Explain in Remarks.)

14.

X

RESULTANT SENTENCES,

a. REPRIMAND

c. DETENTION

PUNISHMENTS, b. ADMONITION

d. FORFEITURE

OR ADMINISTRATIVE (1) ORAL

e. FINED

ACTION X (2) IN WRITING

S / MONTHS

f. REDUCED FROM TO 1 1g. EXTRA DUTY FOR DAYS 1 1h. RESTRICTED FOR DAYS

i. CORRECTIONAL CUSTODY FOR DAYS ❑

j. CONFINED YEARS MONTHS

k. PUNITIVE DISCHARGE ADJUDGED TYPE:

I. ADMINISTRATIVE DISCHARGE EFFECTIVE DATE

m. OTHER (For example, suspension of driving privileges. Explain in Remarks.)

DA FORM 4833, DEC 1998 DA FORM 4833, JUN 80, IS OBSOLETE

OUth,,J1 01145

DODDOACID 007258

ACLU-RDI 134 p.1

(0 -4-c,,-3, 6(v-3 16a. TYPED NAME AND GRADE OF COMMANDING OFFICER

0 5

TC

15. REMARKS

01146

DODDOACID 007259

16c. DATE OF REPORT (YYYYMMDD)

2003 0(402,1

ACLU-RDI 134 p.2

CIRC-AB

DEPARTMENT OF THE ARMY 10th MILITARY POLICE DETACHMENT (CID) (FWD) THIRD MILITARY POLICE GROUP (CID), USACIDC

CAMP BUCCA, UM QASR APO, AE 09375

19 May 2003

MEMORANDUM FOR SEE DISTRIBUTION

SUBJECT: CID REPORT OF INVESTIGATION - INITIAL/FINAL(C) - 0033-03-0D519-6 2149-

5Y2B5/5Y1D2

DATES/TIMES/LOCATIONS OF OCCURRENCES: 1. 12 May 2003/0500 — 12 May 2003/0600; Guard Tower 73, Camp Bucca, Urn Qasr, Iraq, APO, AE 09367

DATE/TIME REPORTED: 14 May 2003, 1100Z

INVESTIGATED BY: SA

foCo -1-1 VICTIM: 1. NIADVE41%;//4/11/11CIV; Internee Identification Number M;

ARABIC; (NFI) ZZ [RECKLESS ENGANGERMENT].

2. U.S. GOVERNMENT (Camp Bucca, Iraq) (FAILURE TO OBEY ORDER OR

REGULATION]

INVESTIGATIVE SUMMARY:

This is an "Operation Iraqi Freedom" investigation. The delay in dispatching this report was due to the lack of secure communications capabilities for CID at Camp Bucca, Urn Qasr, Iraq.

.12k3 This investigation was initiated based on information received from COL 1111=1111111110111 Commander, Camp Bucca, Iraq who notified this office of a possible fatal shooting of a civilian by a tower guard at the Camp Bucca Internment Facility, Iraq. COIAIMNI reported on 12 May 03, there was an incidentb1 41, b1.•

where a tower guard observed an unidentified individual attempting to cross the south berm of the compound. A warning shot was fired and the individual was apprehended and appeared to have had an abrasion on his face. He was taken to the Battalion Aide Station for medical treatment where it was subsequently determined he suffered a gun shot wound to the face and was subsequently evacuated to an unknown location. COL MO explained he had heard information that suggested the individual hadIrle-s,i4r5

succumbed to his wounds and was deceased at the Medical Facility where he was treated.

j (4)

0114'7

SUBJECT: 1. PFC;d1111111111•111111.1111111111.1.11.1111111.11111111; M;

BLACK; 822"d MP Company, Camp Bucca, Iraq; RC [RECKLESS ENDANGERMENT ] [FAILURE TO OBEY ORDER OR REGULATON]

DODDOACID 007260

ACLU-RDI 134 p.3

Investigation established probable cause to believe PFiiii A committed the offenses of Failure to Obey Order or Regulation and Reckless Endangerment when he, while acting in his capacity as a Camp Bucca Perimeter Guard, failed to follow the prescribed Rules Of Engagement (ROE) orders detailing the use of wa i s o s to deter individuals from entering or exiting the camp. PFC MOM Wicri observed Mr. Mr. approaching the outer perimeter o at, Rile and instructed him to

an halt, (both in Arabic and English) when he failed to stop, PFC fire shot, utilizing a 12 Gauge Shotgun. The warning shot was fired in the direction of Mr. feet instead of in asafe di ction as ordered by the ROE and Camp Bucca Force Protection Order. Mr. 411111.11 bic-'1 i b(0"1

was struck in the face by one projectile and was treated for his injuries at a U.S. Army .-q

Medical Facility and then turned over to an Iraqi Civilian Hospital in Bagdand, Iraq. Mr.41111/Mb1e- -4 1WY

alMatila was expected to make a full recovery from his injuries. }c 44 i 6.-41

STATUTES:

ARTICLE 92; UCMJ: FAILURE TO OBEY ORDER OR REGULATION ARTICLE 134; UCMJ: RECKLESS ENDANGERMENT

EXHIBITS/SUBSTANTIATION:

Attached: 4 *A

1. Agent's Investigative Report (AIR) of SAINNENNE, 19 May 03, detailing the initial notification, receipt of SIR from 800 th TOC, coordination with Camp Bucca Medical Facility, shooting scene examination, command coordination, interview of SPOININIk interview of SSG and b1c-411)64

111•11.

receipt and *view of statement of PFC , interview of CAPTOR/a, rights

advisement of PFC ORM receipt of ROE for Camp Bucca, receipt of MAJaNiiiinistatement, receipt of CPT/NONNITSMIMstatement, receipt of SPC L statement, test fire of

weapon and final SJA coordination.

2. Accident/Serious Incident Report, dated 12 May 03, detailing the initial information received by the 800°1 MP BDE TOC pertaining to the shooting at the Internment Facility.

3. Crime Scene Sketch, prepared by SAmium. on 15 May 03, depicting the shooting scene and surrounding area.

tg_qcife-s" 4. Hand Written statement of PFC 41111■11 prepared immediately after the inciderit; 12 May 03.

Cka,21/2i -b 5. Non-Waiver Certificate of PFCIIIIIMIN, 16 May103.

6. Force Protection Plan for EPW Camp Bucca

7. Sworn Statement of MAJMNIIIIMIN16 May 03, detailing the collecting of PFC weapons.

8. Sworn Statement of CPT gimiwomim 17 May 03, detailing the collection of PFC weapons and conducting the round count.

JVO, 01145

DODDOACID 007261

ACLU-RDI 134 p.4

REPORT APPROVED BY: 191 Cr- I , •-•1

•

pecial Agent in Charge

011 4 9 J V t _

c.."1W0 9. Sworn statement of SPC1■1■111=10, 17 May 03rdetailing the function's check on PFC

MINIM weapons.(ac•s i - 5—

10. Compac disk 00330351962149, containing all images exposed during this investigation.

4

Not Attached:

None. 4

'The originals of Exhibits 1 through 10 are forwarded to CRC with the final copy of this report.

STATUS: This is an Initial/Final (C) Report. This investigation was terminated in accordance with CID Regulation 195-1, paragraph 4-17a(6), in that the Special Agent in Charge has determined the furtherance of the investigation would be of little or no value or leads remaining to be developed are not

significant.

LEADS REMAINING: Interview victim, collection of weapon, laboratory examination on weapon

collection of medical records of victim.

• %.

a.

REPORT PREPARED BY:

( 10 -

pecial Agent,

DISTRIBUTION:

1 - (original) Director, U.S. Army Crime Records Center, ATTN: CICR-CR, 6010 6th St, Fort Belvoir,

VA 22060

1 - CDR, 10th MP BN (CID) (FWD) (ATTN: Operations Officer), APO, AE 09304, (Email only/Less

Exhibits) 1— CDR, 3'd MP GRP, (FWD) (ATTN: Operations Officer), APO, AE 09366 1— CDR, 800th Military Police Brigade (COLS, Camp Bucca, APO AE 09367 (Email only/Less

Exhibits) - CDR, 800th Military Police Brigade, .$-3, (ATTN: MAJ1, Camp Bucca, APO AE 09375

(Email only/Less Exhibits) - CDR, 724th Military Police Battalion (ATTN: LTC.11111111111,, Camp Bucca, APO, AE 09375

(Email only/Less Exhibits) 1 — File

DODDOACID 007262

ACLU-RDI 134 p.5

AGENT'S INVESTIGATION REPORT ROI NUMBER

0033-03-CID519-62149

CID Regulation 195-1

PAGE 1 OF 4 PAGES

DETAILS Basis for Investigation: About 1100Z, 14 May 03, COL , Commander, Camp Bucca, Iraq notified this

office of a possible fatal shooting of a civilian by a tower guard at the Camp Bucca Internment Facility, Iraq. COLON. reported on 12 May 03, there was an incident where a tower guard observed an unidentified individual attempting to cross the south berm of the compound. A waning shot was fired and the individual was apprehended and appeared to have had an abrasion on his face. He was taken to the Camp Medical Center where it was subsequently determined he suffered a gun shot wound to the face and was subsequently evacuated to an unknown location. COLONS explained

he had heard information that suggested the individual had succumbed to his wound and pasted away at the Medical Facility where he was treated. No further information as available at the time.

cjjai-/ About 1200Z, 14 May 03, SA received and reviewed the Accident/Serious Incident Report (SIR) generated by

the 822nd MP Company detailing the shooting. The SIR reported the guard in Watch Tower 73 fired a warning shot at an unidentified civilian male when he failed to respond to and order to stop in both Arabic and English. The warning shot was allegedly one round of 00 Buck Shot fired from a 12 Gauge Shot Gun. There was no mention of the victim being struck by the round and the report indicated the victim was taken into custody without incident. (See SIR for additional

details) 1ki_o -I 1,A.L.102vy

About 1210Z, 14 May 03, SAgme. coordinated with CPT■, Camp Bucca Medical Facility, Camp Bucca, Iraq who initially treated the civilian victim when he was brought into the Medical Facility. CP111111111111 explained the victim was brought to the tent with what appeared to be a laceration on his upper left cheek. After examining an X-Ray, it was determine there was a projectile consistent with the shape and size of a 9MM round lodged in his neck. CPT 1

treated the wound and arranged to have the victim Medically Evacuated to Camp Viper, which is the nearest Field Surgical Hos ' al. About 00500Z, 12 May 03, the victim was transported by a U.S. Arm pter destined for Camp

Viper. CP was unsure of the victim's current status or whereabouts. CPT was not able to provide

this office with any identification on the victim as the medical records had been transported with the victim. -/

SHOOTING CRIME SCENE EXAMINATION: About 0600Z, 15 May 03, SA traveled to the Camp Bucca

Internment Facility, Camp Bucca, Iraq to conduct a shooting scene examination of the area where the alleged fatal

shooting took place:

Characteristics of Scene: The shooting scene was located in the southeast corner of the Camp Bucca Internment Facility (QU7839227814) and was identified as Guard Tower 73. The guard tower was a metal and wood tower, approximately 12 feet high (to the standing platform) by 12 feet deep by 7 feet wide. The tower was located approximately ten feet south of the inner perimeter (triple strand concertina wire) and about 62 feet north of the outer perimeter (berm). There was a 21 feet wide gravel road located 41 feet south of the tower, running east/west between the guard towers and the outer berm. Immediately north of Guard Tower 73 was the Internment Facility. To the south of the bum was open desert with approximately 15 miles of open visibility_ The berm itself was constructed of loose sand and was approximately 10 feet tall and encircled the entire Internment Facility. The distance from the southwest corner of the guard tower where the shot was fired from to the top of the berm where the victim was standing was approximately 81 feet. The elevation of the tower and the bum placed both the shooter and the victim at generally the same height.

Condition of Scene: The shooting scene itself was unremarkable as several days had past since the incident and the area was generally sterile. There were no signs of the shooting or even footprints remaining in the sand where the victim had approached the berm, as over the last several days, there had been strong winds and the sand had covered the entire area. There were no indications anyone had been walking outside the berm_

TYPED AGENT'S NAME AND SEQUENCE NUMBER

S A 1.16610

SIGNATURE blc, - (.4„

ORGANIZATION

733MP BN (CID), 6m, MP Group, Camp Bucca, Um Qasr, Iraq APO AE 09375 DATE EXIBBIT

19 May 03

Jut;. t_

01150 DODDOACID 007263

ACLU-RDI 134 p.6


0033-03-013519-62149

CLD Regulation 195-1

PAGE 2 OF 4 PAGES

DETAIIS

Factors Pertinent to Entry/Exit: Access to the shooting scene could be gained on foot or by vehicle from the south, east and west and access would be totally unobstructed. The area around the internment facility is open desert and not

restricted in anyway.

Environmental Condftion: At the time of the shooting, it was approximately 80 degrees and sunny with a slight wind. Visibility was approximately four or five miles.

toaildit6e0 Scene Documentation: SA xposed several photogra of the guard tower, location of the victim and the

area around the shooting scene utilizing a digital camera. SA also prepared a sketch of the scene depicting

the guard tower and location of the victim and the measurement between both.

Collection of Evidence: No evidence was collected at the scene.

Search for Latent Prints: A search for latent prints was not conducted as it was not applicable to the current investigation. A search for foot impression was conducted around the location where the victim was seen crossing the berm but due to the consistency of the sand the weather over the previous several days, not foot impression were

discovered.

Search Beyond the Scene: A search beyond the scene was conducted for any additional information or evidence pertaining the shooting. Nothing remarkable was discovered during the search. The search was limited to the area close to the perimeter berm as there are believed to be land mines outside the berm.

,Letr.,:Ljak-c loq)-3 About 0650Z, 15 May 03, SA.111101Pcoordinated with and interviewed LTC Commander, 724th MP Battalion, Camp Bucca, Iraq. SAIIIMPadvised LTC at CID was assuming

investigative responsibility of this incident due to a request by COL LTC xplained she did not have

any direct information pertaining to the incident but would make her personnel available for interviews as soon as

possible. 19 -

About 0700Z, 15 May 03, SA interviewed SPC 0822ncl MP Company, Camp

Bucca, Iraq who was assigned to the guard tower immediately west of the incident location. SPC was also the

individual who subsequently apprehended the victim. SPC 11111.reported on the morning of 12 ay 3, approximately 0800 local (0500Z) he heard what he believed to be a gunshot coming from the Tower to the east of his position (rower 73). Due to the location of the generator and the noise it was making, he was not immediately sure he heard a gun shot.

When SPC timed around, he observed an individual running outside the berm towards his position. He immediately drew his side arm and commanded the individual to halt. The individual came over the berm and stopped just below SPC..11101Iguard tower and sat on the ground. At the same time, two roving patrols arrived on the scene and took the individual into custody. SRC...reported seeing blood coming from the individuals face and mouth but he did not appear to be seriously injured. The roving patrols were then ordered to take the victim to the Medical Facility for treatment. When asked if he witnessed any weapons in the victim's possession, SPCSIIIMIstated he believed the individual was carrying a stick approximately two feet in length. SPG1/1111.was not able to provide any addition information pertaining to the incident on 12 May 03. ID -4096 • q


• • b SA SIGN _ 1

ORGANIZATION 733MP BN (CID), 6TH, MP Group, Camp Bucca, Urn Qasr, Iraq APO AE 09375 DATE 19 May 03

J ti


ACLU-RDI 134 p.7


0033-03-C1D519-62149

CID Regulation 195-1

PAGE 3 OF 4 PAGES

srrAUS

0800Z, 15 May 03, S 14111101fr"ntt erviewed SSGI111411 .611111 tali1111 1110 and SGThiiiiiit.4

both from 822nd MP Company, Cam Bucca, Iraq who were both traveling together as the roving

patrol around the Internment Facility on 12 May 03. and SGT both explained about 0500Z, 12

May 03, they responded to a radio call of a shooting on the south perimeter. Upon their arrival at SPCA position, they observed an unidentified civilian sitting on the ground bleeding from the face and mouth. They immediately took the individual into custody without incident and brought him to the Camp Bucca Medical Facility for treatment of his

wounds. 464"

b Gs About 0900Z, 15 May 03, SA received and reviewed a hand written statement prepared by PF

1111111111111111.1111./111 822nd MP Company, Camp Bucca, Iraq immediately following the incident. PFCGIIIIMIWee the guard on duty at Tower 73 and was the soldier who fired the warning shot. The statement detailed the incident on 12

May 03 as described by PFC In the statement, PFC11.1011111reports seeing an individual approaching the outer berm of the Interment Facility and he immediately called out halt in both Arabic and English, when the individual refused to stop, he fired one warning short with a 12 gauge shotgun, loaded with lethal ammunition, at the feet of the individual. The statement further explains, after the waiving shot, the individual turned and ran back outside the burn, and headed west until he reached the next Guard Tower where he re-crossed the berm and surrendered to the guard at the tower. (See hand written statement of PFM111111111for details)

" About 1000Z,15 May 03, SAVIiiikdeparted Camp Bucca, Iraq traveling to the Camp Viper Medical Facility, Iraq to locate and determine the status of the individual who was alleged shot at and wounded by PFC Upon arrival

at Camp Viper, SA was able to identify the victim as Mr No further

identification was available as all medical records had been forwarded to the Baghdad Training Hospital, Baghdad, Iraq.

About 1200Z, 15 May 03, i interviewed nterviewed CAPT (0-6) Director of Medical Services, U.S. ala

Navy Surgical Hospital, Camp Viper, Iraq who was the commander of the field hospital. CAPTIIIIIIMbexplained on 12

May 03, Mr. was brought into the hospital with a single gunshot wound to the right cheek. Upon further examination and examination of the X-Rays, it was determined a projectile was lodged in his neck resting against an artery. CAP11111110explained the projectile could not be removed without causing further injury so it was left in place. CAPllIllIllIllexplained, with proper medical care, mr.1111.1111111111Swas expected to make a full recovery. CAPT

1111111110iso reported Mr.111111111.1111•1111and all of his medical records and X-Rays were forwarded to the civilian medical

personnel at the Baghdad H I and unfortmately, there were no records available. CAPT did state the

projectile lodged in Mr. neck was not consistent with a shot from a 12 Gauge Shotgun and based on his

experience and the observations of his staff, the projectile lodged in the victims neck was consistent with the shape and size of a 9mm round. CAPTallibreported seeing three to four gunshot wounds a day come through the Field Hospital and he was certain of the size and shape of the projectile. CAPT was not able to provide any additional information pertaining to this investigation, and when questioned about how Camp Bucca could have been incorrectly notified that Mr11111.1111111.11111111itad passed away, he explained the communication from the hospital are sometirnes relayed though two or three before they reach there destination and mix ups happen. CAPAIIIII)assured SA

111111111111111)that when Mr. departed his hospital on 14 May 03, he was alive and well

About 0612Z, 16 May 03,Sk g his legal rights for the offenses of Reckless kkdvised Endangerment and Failure to Obey Order or Regulation which he invoked and requested legal counsel. The interview was subsequently terminated and PFC*1111111was released back to his unit.

TYPED AGENTS NAME AND SEQUENCE NUMBER ORGANIZATION

b - bl 733MP BN (CID), 6m, MP Group, Camp Bucca, Um

SA Qasr, Iraq APO AE 09375 SIGNATURE DATE EXHIBIT

19 May 03

• 3


blc.- 1 (p c, -I

ACLU-RDI 134 p.8


0033-03-C1D519-62149

CID Regulation 195-1 PAGE 4 OF 4 PAGES

1 cr.,,Lkfaq About 1100Z,19 May 03, SA mmomp and CPT

ka I11■11111111111111111(rimarms Instructor) conducted a test fire of PFC

11111111.1102 Gauge Shot Gun utilizing a cardboard target to determine the actual spread of the 00 Buck Pellets at 81 Feet to verify the validity of PFC1111.11111statement. The test, which was conducted by firing three shots from PFC

position at a target located in the position the victim was standing, determined the average pattern s rea of the 9 pellets was 242 inches high by 162 inches wide. Based on the test fires, it is the opinion of CPT that the warning shot would have had to be aimed somewhere between the chest and 12 to 14 inches above the head for a round to have struck the victim. Therefore, PFC anikaccounts of the incident could not be accurate.

About 1300Z, 19 May 03, SA irliiiriefed MAJ MP Group, Legal Counsel, Camp Bucca,

Iraq on the details of this investigation. MAJ 1110111111bopined there was probable cause to believe PFC committed the offenses of Reckless Endangerment and Failure to Obey Order or Regulation when he disregarded the Camp Bucca Force Protection Rules of Engagement and fired a warning shot in the direction of an approaching civilian which stuck the civilian causing injuryth/LAST ENTRY///

DETAILS 10 C I About 0650Z, 16 May 03, SA reived and reviewed the Rules of Engagement for the Camp Bucca Internee Facility. Rule 4(2) clearly states Warning Shots are authorized but must be fired in a safe direction away from all prisoners, civilians and US/Coalition personnel. (See Force Protection Plan for EPW Camp Bucca for further details)

(..-, - -1 - -

About 18 May 03 SA mived and reviewed the sworn statements of MAJ and

C from 724th MP Bn, Camp Bucca, Iraq which detailed there actions when requested to

obtain SPC weapons and conduct a round count of his 9MM ammunition. (See Statements for details) 101-4- * b

About 1230Z, 18 May 03,SAt.11111111kreceived47 -1 and reviewed the statement of SPC

allOUnit Armorer , 724th MP Bn, Bucca, Iraq which detailed the Functions check conducted on all three of PFC

IllmigNssued weapons. SPC ed all three weapons (M-9, M-16 and 12 Gauge Shot Gun) were

Functional and able to be fired.


SA SIGNATURE

ORGANIZATION

733MP BN (CID), 6m, MP Group, Camp Bucca, Um Qasr, Iraq APO AE 09375 DATE

19 May 03 EXHIBIT


ACLU-RDI 134 p.9

Page(s)

io -

Referred to:

U.S. CENTRAL COMMAND 7115 SOUTH BOUNDARY BLVD ATTN: CCJ6-DM MACDILL AIR FORCE BASE FLORIDA 33621-5101

MS. JACQUELINE SCOTT [email protected] (813) 827-5341/2830

ACLU-RDI 134 p.10

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DODDOACID 007268

ACLU-RDI 134 p.11

Page(s)

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01156

DODDOACID 007269

ACLU-RDI 134 p.12

2a. NAME (Type or Print)

h

I a. NAME (Type or Print)

\ b. ORGANIZAT: — ] ' - - - --"' ' - -, —

ORGANIZATION OR ADDRESS AND PHONE

c. - I

YPED NAME OF INVESTIGATOR

s A ORGANIZATION OF INVESTIGATOR

.7 -/ r/ /•'( j) Off ar L)C F 420.)

For use of this form, sea AR 190-30: the propenant agancy t5 UULbilY

DATA REDUIRED BY THE PRIVACY ACT

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

Title 10, United States Code, Section 30121g) To provide commanders and law enforcement of licials with means by which information may he accurately identified.

Your Social Security Number is used as an additionallalternate means of identification to facilitate tiling and retrieval.

disclosure of your Social Security Number is voluntary. le- ,614-76"

2. DATE Tlfa I f :CATION

ORGAI IZATION OR ADDRESS

F3.7?-8 fila Co.

WITNESSES Ill available'

b (..-,6" 649 marrimw PART I - RIGHTS WAIVERINON-WAIVER CERTIFICATE

Section A. Rights

The investigator whose name appears below told me that helshe is with the United States Army

•—•••• I P.17;

7 ; - 17 . '7' - 7 •

suspectedlaccused: Pr I e- r.,•1,,. c2:14.4 r ksey „,

.3efore he/she asked me any questions about the of fenselsI. however, helshe made it clear to me that I have the following rights:

1. Ido not have to answer any question at say anything.

2.Anything I say or do can be used as evidence against me in a criminal trial.

3. (For personnel subject othe UCMJ I have the right to talk privately to a lawyer before, during, and after questioning and to have a lawyer present with me

during questioning. This lawyer can be a civilian lawyer I arrange for at no expense to the Government or a military lawyer detailed :or meet na ex;:ansa to me,

or both.

'Fvr civilians not subject to the IlC,11J) I have the right to talk privately to a lawyer before, during, and after questioning and to have a lawyer present with

me during questioning. I understand that this lawyer can be one that I arrange for at my own expense, or if I cannot afford a lawyer and want one, a lawyer

will be appointed for me before any questioning begins.

if 1 3m now willing to discuss the of fensels1 under investigation, with or without a lawyer present. I have

a right to stop answering questions at any time, or

speak privately with a lawyer before answering further, even if I sign the waiver below.

5. COMMENTS IContinve on reverse side)

Section B. Waiver

I understand my rights es stated above. I am now willing to discuss the offensels1 under investigation and make a statement without talking

to a lawyer first and without having a lawyer present with me.

3. SIGNATURE OF INTERVIP;EE

Section C. Non -waiver

❑ Ida not want to he questioned 01 say anything

1:14 I want a lawyer

ERVIEWEE rve j.„ a7/41 its _571Z,,,,i0/ . /,‘Piffe k4.16-4141x/ex,

ACH THIS WAIVER CERTIFICATE TO ANY SWORN STATEMENT IDA FCX,1 EAECjiTiG 31 THE SUSPECT:AE'CUS'--_- D "1

DA FORM 3881, NOV 89 F217:2!! CT ORSOLETE

DODDOACID 007270

ACLU-RDI 134 p.13

Page(s)

!g •

•

Referred to:



01158

DODDOACID 007271

ACLU-RDI 134 p.14

AUTHORITY: PRINCIPAL PURPOSE:

ROUTINE

USE

DISCLOSUIle


Tide 10 USC Section 301; Tide 5 USC Section 2951; E.O. 9397 dated November 22, 1943 (SSM.

alternate means of identification To provide commanders and law enforcement o ffwiats with means by which information may be accurately identified

Your social security number is used as an additional/tification to faclitate filing and retrieval.

Disclosure of social number

O fj 0 S 15 0 3 4-1" laPP

/--rzr fi7"

—i \w"‹ L-f.-vOoy---c C-aor--% L

Co„d a,..)4 D%) C frilairzy 77 -

4 J 4 1.1 ) d9 . i9..5

104- IX -t-n6zi 7”- 7

► r7) 5. /3/7yop

c5d43 9'n Y12,,i; cres1-2,

WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:

Zv3J laa,c, )4--14-rk ler

tart: -r/z )t -y<z

lofr3

-4 Ida-Li

TAKEN AT DATED

ADDI770NAL PAGES MUST CONTAIN THE HEADING STATEMENT OF_

THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT, AND PAGE NUMBER USAPA V1.00

DA FORM 2823, JUL 72, IS OBSOLETE

9

MUST BE BE INDICATED.

DA FORM 2823• DEC 1998

DODDOACID 007272

ACLU-RDI 134 p.15

0035.03 C OS- 1 61- 62./ ki

SWORN STATEMENT For use of this form, see AR 190-45; the proponent agency is ODCSOPS

PRIVACY ACT STATEMENT AUTHORITY: Title 10 USC Section 301; Title 5 USC Section 2951; E.O. 9397 dated November 22, 1943 (SSNI.

PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified.

ROUTINE USES: Sour social security number is used as an additional/alternate means of identification to facilitate filing and retrieval.

DISCLOSURE: Disclosure of your social security number is voluntary. (01-C 1Up' 11 1. LOCATION CAMP BUCCA, IRAQ

2. DATE (YYYYMMDD) 2003/05/17

3. TIME 4'7'46 AD`'

L-4. FILE NUMBER

V-c amitur viiirairimiNAloME -4 i be.-"( 6. SSN - la - (4 7. GRADE/STUS TA

CPT 8. ORGANIZATION OR ADDRESS 724TH MP BN CAMP BUCCA, IRAQ APO A.E. 09375 9.

CPT , WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH: siiiiiiiiiiim

C.-- -

On 14 May 2003 was ordered by LT o retrieve PFC 5.

weapons from his custody, conducted a round count of his 9 mm handgun, and take into custody any evidence that was recovered by his Company chain of Command MM

d I went to the Com area and spoke with ompany Commander, 1LTIIMINM We explained that the circumstance's surrounding ooting had changed from a warning shot to a potential shooting. We then went to the Platoon leader, 1LT and his Sergeant, SSG and PFC./Mnd explained that we needed PFC.Mftweapons and conduct a round count of his 9mm handgun. MAJ took custody of PFC M-16, which he was not carrying during the incident, his 9mm handgun, and his Shotgun. spoke with SSG an retrieved

• 1 9mm magazine that was issued to him and returned (15) 9mm rounds back to her that indicated a full magazine. SSG also produced one Winchester "00" buck round that had been discharged. She stair directly after the shooting

she went to the ene of tower 73 and retrieved the round at the base of the tower were PFC was occupying during the incident. SSG tated she had custody of the round until she turned it over to me. The weapon's were turned over to the Battalion Armor for further testing. The shotgun round was collected as evidence, sealed in a brown envelope with an attached chain of custody and turned over to MSG J3N S-2 NCO, placed into a secure safe maintained by him that is located in the BN TOC. //l

b9r3 / (0(•-3

f/ END 8 -CS112rr E,IVA ff%, 7 \ \ 4 - I

109 C- b6-41 10. EXHIBIT 1 11. INITIALS OF PE TEMENT

PAGE 1 OF PAGES 1

ADDITIONAL PAGES MUST CONTAIN THE HEADING 'STATEMENT

THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS MUST BE BE INDICATED.

OF TAKEN AT DATED

OF THE PERSON MAKING THE STATEMENT, AND PAGE NUMBER

DA FORM 2823, DEC 1998 DA FORM 2823, JUL 72, IS OBSOLETE USAPA V1.00

jV 151-1*iC8

DODDOACID 007273

ACLU-RDI 134 p.16

(Authority To Administer Oat )

(To - ure5 - 4, 61 y

STATEMENT OF CP TAKEN AT

DATED 17

9. STATEMENT (Continued)

b -

CPT co— , HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT

WHICH BEGINS ON PAGE 1, AND ENDS ON PAGE A.. LY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE

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 F BE F R WARD, WITHOUT THREAT

OF PUNISHMENT, AND WITHOUT COERCION, UNLAWFUL INFLUENCE, OR 1 6("0

- q

eking Statement)

Subscribed and sworn to before me, a person authorized by law to

administer oaths, this 11 7 day of

at &Hy BliCC

ORGANIZATION OR ADDRESS

WITNESSES:

PAGE 2 OF 2 PAGES

USAPA V1.00

JIJ 01131 . I;


INITIALS OF PERSON MAKING STATEMENT

PAGE 3, DA FORM 2823, DEC 1998

DODDOACID 007274

ACLU-RDI 134 p.17

USAPA V1.00

C)c.)3,3 .0 c

SWORN STATEMENT For use of this form, see AR 190-45; the proponent agency is ODCSOPS

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE: 1. LOCATION CAMP BUCCA, IRAQ

ANIZATION OR ADORESs

111111 , WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:

At approxiamtely 1028 on 17 May 03, I conducted a PMCS/ Function's check on the following weapons: 9mm SER# 1317400, M16A2 SER# 2157957, 12 Gauge Shotgun SERB 033176. The 9mm had rust on the outside of the barrel, rust on the upper operating rod and spring. The 12 Gauge Shotgun magazine spring is inoperable. On all three (3) weapon there is no sign of lubrication and there are no mechanical defficiency, they are also extreamly fi

5. LAST NAME, FIRST NAME, MI DL NAME

taimmim toic-ljto 8. ORG HHD 724th MP Bn


Title 10 USC Section 301; Title 5 USC Section 2951; E.O. 9397 dated November 22, 1943 (SSN).

To provide commanders and law enforcement officials with means by which information may be accurately

Your social security number is used as an additional/alternate means of identification to facilitate filing and retrieval.

Disclosure of your social security number is voluntary. yr , 10(3 - q

2. DATE (YYYYMMDD) 3. TIME I 4. FILE NUMBER

2003/05/17 I 1030 al

6. SSN

7. GRADE/STATUS E-4

lthy. There is build up sand and dirt on internal working parts. The barrel of the Shotgun and the M16 had evidence of being fired. ///END OF STATEMENT/// wic_41 '1

N, S

10. EXHIBIT

PAC-- Igo"!

WO11. INITIAL SON MAKING STATEMENT

104-q

PAGE 1 OF PAGES

ADDITIONAL PAGES MUST CONTAIN THE HEADING "STATEMENT

TAKEN AT DATED

THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT, AND PAGE NUMBER

MUST BE BE INDICATED.

DA FDOM 2823, DEC 1998 DA FORM 2823, JUL 72, IS OBSOLETE

DODDOACID 007275

ACLU-RDI 134 p.18

6,0i3 „ 0 5, c t ti

STATEMENT OF TAKEN AT CAMP BUCCA DATED 2003/05117


S. STATEMENT (Continued)

101Lea1ash66 -` NOT USED our

C.- AFFIDAVIT

, HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT

WHICH BEGINS ON PAGE 1, AND ENDS ON PAGE 2 . I FULLY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE 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 INFLU •NCE, OR UNLAWFUL INDUCEMENT.

b(0-(1

WITNESSES:

igna u e o n tatement)

Subscribed and sworn to before me, a person authorized by law to

administer oaths, this 17 day of MAY , 2003

at C CSA IRA I

Job- - 6 -3 (S(gnatTo rso Administering Oath)

10


INITIALS OF PERSON MAKING STATEMENT

111. IDc-*L1 PAGE 3, DA FORM 2823, DEC 1998

ype . `ame of on Administering Oath)

ART 136 (b) (4) UCMJ (Authority To Administer Oaths)

I PAGE 2 OF 211 USAPA V1.00

174-46"1

DODDOACID 007276

ACLU-RDI 134 p.19

DODDOACID 007277

ACLU-RDI 134 p.20

NEO i9ML-7t2

CRTMTNAL

10(0- I I I

J ^^ -

v-- e 71

8. ASSIGNEE -0

Irkt1c- 60-1t 9. TYPE OF ACTION

- 5"

-- 0_t7C- --------------------- ------- --rf ----------------

I TYPE I SUSPENSE 1 COMP C. 1

VTCTM

7

C"7 --•"7"M

Lt- 41:1 c . :5 COPO -f-Orl.

ArT7cN I RQRD I COMPL I DATE 1 AMOUNT I -------------------------------------------------

------- - - - - - CTHER ACTION I 12: CID FUNDS I

EVIDENCE OUST ja031 111111110,1c.-

CT= =CPM 66 -------------------------------------------------------------------------- _

• 1. =ATE I 2. TIME RECEIVED 7. CAS= NUM==R

7"; -Luh I

:. .• I I _ _ _ _ __ _ ___ __ _ _ _ __ _ _ _ _ _ _ _ _ __ __ _ __ _ _ ___ __ __ _ __ _ _ _

__ I _______ I __________ I ________ I _______ _________ _______ :

i I I I I I I I

I I I I I I I

I I I I i I I I

I I I I I I

0000001

01165

DODDOACID 007278

ACLU-RDI 134 p.21

CONTROL N ..BER 0033-03-CID519-62149 AGENT ACTIVITY SUMMAk._ (CID Regulation 195-1)

1100Z, 14 May 03

IMMO tort 00 Cp-

1200Z, 14 May 03

1210Z, 14 May 03

1400Z, 14 May 03

0600Z, 15 May 04

0650Z. 15 May 03

07002„ 15 May 03

0800Z, 15 May 03

0900Z, 15 May 03

1000Z, 15 May 03

1200Z, 15 May 03

0612Z, 16 May 03

0650Z, 16 May 03

Basis for Investigation: About 1100Z, 14 May 03, COL Commander, Camp Bucca, Iraq notified this office of a possible fatal shooting of a civilian by a tower guard at the Camp Bucca Internment Facility (IF), Iraq. COL reported on 12 May 03, there was an

incident where a tower guard observed an unidentified individual attempting to cross the south burm of the compound_ A warring shot was fired and the individual was apprehended and appeared to have had an abrasion on his face. He was taken to the Camp Medical Tent where it was subsequently determined he suffered a gun shot wound to the face and was subsequently evacuated to an unknovnt locatiar-COLIMIlliexplained he had -heard ittfunmatiou that suggested the individual had succumbed to his wound and pasted away at the Medical Facility where he was treated. No further information as available at the time.

1.01,(12fp -1 About 1200Z, 14 May 03, SA received and reviewed the Accident/Serious Incident

Report (SIR) generated by the 822 thi MP Company detailing the shooting.

About 1210Z, 14 May 03, rdinated with Cliiiiiinalkamp Bucca Medical Facility, Camp Bucca, Iraq who initially treated the civilian victim when he was brought into the Medical Facility.

Briefed n information received from CO Adviitiate

CO to in- preliminary and determine status of victim.

SHOOTING CRIME SCENE EXAMINATION: About 0600Z, 15 May 03, SA traveled to the Camp Bucca Internment Facility, Camp Bucca, Iraq to conduct a shooting scene examination of the area where the alleged final shooting took place_

03.

About 0900Z15 May 03, SA - received and reviewed a hand written statement

prepared by PFC 822nd MP Company, Camp Bucca, Iraq

immediately following the incident.

About 1000Z, 15 May 03, SA departed Camp Bucca, Iraq traveling to Camp Viper Medical Facility, Iraq to locate and determine the status of the individual who was alledgedly shot at and wounded by PFCiambic-soco-s-

About 1200Z, 15 May 03, Sligiti finterviewed CAPT (0-6)Immims Director of Medical Services, U.S. Navy Surgical Hospital, Camp Viper, Iraq who was the commander of

the field hospital. bRe-

About 0612Z, 16 May 03, SA dvised PFC of his legal rights for the offenses of Reckless Endangerment and Failure to Obey Order or Regulaton which he invoked and requested legal counsel.

-(

About 06502., 16 May 03. SA Leceived and reviewed the Rules of Engagement for

the Camp Bucca Internee Facility.

PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUST 0 - - ° 0 0

166 CID FORM 28 'T" on

b/c- I ke 74-1117-3

About 0650Z, 15 May 03, SAMillacoordinated with and interviewed LT 011111111111111111111111111Commander, 724 th MP Battalion, Camp Bucca, Iraq.

About 0700Z, 15 May 03, SA interviewedSPC

grad MP Company, Camp Bucca, Iraq who was assigned to the guard tower immediately west of the incident location.

ba About 0800Z, 15 May 03, SA interviewed SSG

and SGT both from 822thi MP Company, Camp Bucca, Iraq who were both traveling together as the roving patrol around the Internment Facility on 12 May

DODDOACID 007279

ACLU-RDI 134 p.22

About 1100Z, 19 May 03, SA conducted a test fire of PFC determine the actual spreadgf thp KB 11111111110tatementiat. "6

and CPT 'rearms Instructor) 2 Gauge Shot Gun utilizing a cardboard target to

uck Pellets at 81 feet to verify the validity of PFC

' CSS

••••_

AGENT ACTIVITY SUMMARY (CID Regulation 195-1)

CONTROL NUIVHSER -7C-! ' -03-CAMP BUCCA

C.J1.0(fel About 1200Z, 18 May 03, SAlireceived and reviewed the sworn statements of MAJ 1111111111111.11.6and CPTIONMIN krf 0'4 I b(-(

About 1230Z SAkr -1 18 May 03, l ed and reviewed the statement of SPC114//11 tifila ece )10 C1141

About 0900Z, 16 May 03, 17(49-1 - 3rd

riefed MAJ MP Group, the details of this investigation. Legal Counsel, Camp Bucca, Iraq on

Updated case file, drafted and prepared final report, forwarded case to SAC for review

a-9 :212- E- r- T1 . 7-6

7 4,- .4 7) 4_ 1/ i_5 (7 14:2 7- Oho C 10-42,0

A-clb A- 11 CI .x14 /3 )T5 (.1. 5 11 a -"CZ. 2 LL5) leu422cuo

002 syDArlie guct-9(c.c.Vilf Gag, o pke-€40

m be F -, h-e t O 1 -r /3,(. Afrenrr, S)0-)e. 7--c nic57 e

tir Sic e. l g vv\A-A 03 4rY0 ge - .To gfd u13-s-fes.,3(ce. eiv14,), (5 --)L1 cf3)-e-5 v.-2/13-€

polka- S )1(_ C ,S ,*e--r 61 ,9-0c_

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• 1 C d ̀k- --C.

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c-() \_JZ ,,c k>

k.fc -v 13

" 1

1200Z, 18 May 03

1230Z, 18 May 03

1100Z, 19 May 03

1300Z, 19 May 03

1400Z, 19 May 03

b1C.

CID FORM 28

PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSta.ik ,

DODDOACID 007280

ACLU-RDI 134 p.23

AGENT ACTIVITY _ (CID Regulation 195-1)

CONTROL NUM., A

30 &Pi 03 ilifirakric--1 1 10 p.-/

69_ N

.11111110-4„coc,-

ft /1 -e-D gc;7L-- 1-17

C-- /z/tDk -a_ qV3_3 D [a A

93 (3)Nc-- 03 Wan Cod

-`) g33, (A/ Pr-4D de;v4-j 4 `11-b FD ̀i7

C--- Copy FO

(-ILe ro 1-3-0 a Q1-1-2.41.•,,,,, Ors G4A,v,/ .

UMW iceg--( tap-

CID FORM 28 1 OCT 80

PREVIOUS EDITIONS OF THIS FORM WILL BE USED UNTIL EXHAUSTED. n Rglei_vfa

DODDOACID 007281

ACLU-RDI 134 p.24

DEPARTMENT OF THE ARMY 44TH MILITARY POLICE DETACHMENT (CID) (FWD)

UNITED STATES ARMY CRIMINAL INVESTIGATION COMMAND CAMP ARIFJAN, KUWAIT APO AE 09366

S: 30 June 03

CIMPL-FL-FWD (195-2b) 30_May 03 ki4v

MEMORANDUM FOR Commander, 800' h Military Police Brigade, Camp Bucca, APO AE

09367 (ATTN : COL wpm ioq-c_-3,we3

SUBJECT: Report of Investigation 0033-03-CID519-62149

1. The enclosed CID report pertaining to a member(s) of your organization is forwarded for information and action deemed appropriate.

2. AR 195-2, paragraph 1-5e requires that commanders/supervisors receiving CID reports for action must reply to the CID unit initiating the report indicating the judicial, nonjudicial, or administrative action, or lack thereof, taken against persons listed in the subject section of the report. Changes resulting from appellate action must also be reported.

3. Commanders/supervisors must also notify all persons against whom no action is taken, that their name will remain in the title section of the report, and that the report will be indexed and retrievable by their name. These persons will also be informed of the purposes for which the reports are used (e.g., other criminal investigations, security clearances, and other purposes as authorized by the Privacy Act and AR 340-21) and the fact that such use may have an impact upon their military careers.

4. Request that you use the enclosed DA Form 4833 to provide the required information as soon as disciplinary or administrative action is completed.

b c-- l 10 I

2 Encls Special Agent-in-Charge

CID FL 23-R (Previous editions of this form letter are obsolete) 1 Jan 81

FOR OFFICIAL USE ONLY

%; . 01169

DODDOACID 007282

ACLU-RDI 134 p.25

DATA REQUIRED BY PRIVACY ACT

AUTHORITY: Title 10. United States Code Section 3012 (g) ROUTINE USES: Your social security number and other personal information Arc used as an additional alternate means of identification to facilitate and retrieval.

PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with DISCLOSURE: Disclosure of your social security # is voluntary

means by which information may be accurately identified.

1. Rec Code: 2. Action Code: 3. Date:

. . 10 ast Name: jr. ,

4. Rel to Case: 5. Control: 6. Sequence z-' 7. Year: 8. Office 9. ROI # Offense:

- CID - - . . . ....._...„.. .... . „,_..

1 First Name: 12. Middle Name: 13. Grade/Rank:

b4z--tf b(p-cy err bow-. - Lt ecurttv Nu I. 15. Other ID Number. rib,. • f B It t: b 17. POB Ci

r_.! 18. PCB St: 19. POB Zi •

I. { .

,,,//:(. • ex:. ' ace: 22. thnic: 23. eight:

3 N-CAA: h d A 5` ',,p." C---

24 Weight: 2 . : 26. Eye Color: . amen.

1 ■ 0 8(zrk-) II 24) /M-i-e-/ • •

- cord:

A)1,.4

31. MOS:

Ct ?-

32. Job Description/Location:

2 ,. - a_ 190?_Plo 33. MC -

C 34. Security Clr:

Ahry,-c Ph sical Iv ark Tattoos:

640:cf 1,6,1 1

36. Spouse Military: Branch:

Yes: ■ No:

37. Alias/Nicknames: 61..)/i8

38. Alias/Nicknames:

i (-/ /-q-

39. Alias/Nicknames:

74/:'t

40. Unit/ Organization: w, '4 14 14-b 1-7 a 4. rl t? r3

42. Military Service: 43. Sub Unit: 44. Fort/City:

I 9,..VA. C y-v-t g

48. Ho .. . , :. .4:6'.51111 '" g +-7/ 1=1" %Mr

•ritaa%Ti ra, . iiig, 31 i 6 d A ' a ie 4 t a TM -MUM

53. JUV: 54. Family Rel: 55. Last Name:

0 C- C2

56. First

41. Unit Phone Number: Home:

4C..- to -

46. Country. S., 2_ A.

50. State: I. Coun :

' . ''

Name: 57 Middle

Cell/Pager.

47. Zip Code/APO:

.10 fi i_ 6,1 ?_5---

irof tp Code/APO:

. 1 4 Name:

58. Social Security: 59. Grade/Rank: 60. MC: 61. Unit:

62. City: r 63. State: T 64. ZIP/APO: 65. Phone: Wk: Um:

rT ' '1, ... ,. 66. Offense Code:

-.7...,-,.-v,,,,->,,,,,, w ,,,, ' giA.Iiii -

Telephone:

, .:, ' 67. UFC:

, -,." ..,71,7

. ETS:

, , ,

68. Offense Code:

, 1", , "7-0,7,77 . ' ' '

. 69. UFC:

PCS/DEROS: 1,:f0.1174.12.a7,7

, V,Ilq:-..S.Iir,Lz,._ ._,,, 70. Offense Code:

. :

Date /

•it.i, ' .e..4 ?..-,-._ L _

71. UFC: 72. Offense Code:

„ --„„, - ,-_ , '-'" ,; ,_

Time Interview START: Date: Time:

2,

73. UFC:

- , 4,,

Place of Interview: Date / Time Interview END: Date: Time:

Disposition:

. • '. ' PIWPOttlairkettiki)0A--

74. Category: 75. Type: 76. Recovered: Yes: ■ No: ■

77. Value: 78. Insurer: Policy: Year/Date Exp: /

79. Year 80. Make: 81. Model: 82. Vehicle Style: 83. 4 of Doors: 84. Color: 85. Size:

86. V I.N• 87 License Plate: 88 State: 89 DOD Decal Number:

NOTES:

LAST HIV TEST: CID FORM 44-R...0nItne version

1999

01170

DODDOACID 007283

ACLU-RDI 134 p.26

INVESTIGATIVE WORKSHEET

DATA REQUIRED EY 7FM PRIVAC".' ACT

WTHORT:Y: ".de 10, Up:MA Snare Cade, Secrim x11240, ROtTC'tE URFS- your toad .miry cumber .ad ocher inicrmawxn re tued x.4 se addIrce.s.1.1 wrrurc :-..ws.n. ri

iclearciacce to ..e.•-• , ■• 4..:=14( and rrawr4-I-

?Rr.4cr.,..:_ pl,-Rpco.-, To .0.v-h..Ie •c••erideci and Lrw eribrcemerd otticiAi∎ wi6t Eocene try which kraccaLwion rary be Jccurwriy Idecreied_ DLSO-051_71 ,n D‘riosurr DI your icciAl wcirriry member 4 rceuracery

1 ."... MEE 2 MCN CITF 3 CATE SUBMITTED i 4 Sal MA( GER c 5 YEAR I. 6 UNIT 17 i I

7 POI NUAN3a. Sa :13 CASE i._ 9 MITE°. /

. 111 .

21 1 41 21 .A 4

INDIVIDVAL. DATA

:o , I: 14AuE '51 b frS- i 11 IRST . E

20 I •10-7-15 ) 10601S 12 u1001 £u1001£-E WA loa-4.5-13 WADE

i- 6--3

15 I

7.2

-: (V'

I,.... MY litilk-F1 lign-051- V WILBER ,

, .ftrl. 6,••,5*. ...wr

SEX ' 71 ?..10E 1 :77.-hiC : 22 hEiGHT

11 akii 1 . -0 , acs 1 .......: uu.:: , 22 R:7c....(T'04

S ii MP

74 WEX:ra I n

,16. 3 i Bi 3.4 INDUSTRY

r Ye tog-- __• • 15

IVR CaDi DE. M-Cfl

k 5 1 6 1 - 11 5 I 35 szcam 1 :6 Prorsr.x. kws

I

77 CMZEN

, s -

2

Mall1111,..

N ALAS-W014AME

.... ........ IIIII4M-57 1$ Pe&CFY

1 2 I 1 .61-C.--5 #, ..15 I

M 0.:C ■ 27 rhea I X 14,14,1TAL. I

/2_ 2; /1-0.4-s(:_ 21 (5

•

37 ALIAS-NICXNAJJE(S) 33 ALIAS-44 CKNAL1E

-- • 70 ..

40 CFGANILUIC61

P-9-^ Nt. P t° n I 41 IF CDNERACTCR, CONTRACT /

(2 1.0LITARY SVC 43 SUBUNIT , 4-4 FM/MY 1 lt,'iia. 4e3 M.: 1 1

I

47 17,P cnaixpo

1 ;1

.4.i AD:Pc.L.'S

m.-

I 49 CITY I

. Is I

SCI STAIT 1

SI ciawrxr

:1 7

52 :DP crcEmpo a 1

FAMILY MEMBER DATA

, ,,-, .',...2-1 . _ t .=::_. •-..-, Ellis:Y..1' 1 :_A.:,-; N.4141E 1

1I 1 20 4 -

; SX-IRSLY1 P.m.."`S; 'WIS.

I - 15

I 57 ErTh'il ',UCCLE I.1.1 44E

I 1S

:Z .S.M.k. SEC.1: WY Hu Lae SPCti GRAZ( i 60 SPal LACI.: 1 31 SPONS01 UNIT Aaffs_.5.5

..4-, :::7!

- 11

::.:.3 SKIN S-7 ..)/ SPC41 ::' f...5 SKI. C.? M2FJ APO

___.5E 55 CITEN.SE CEDE 67 UFC 1 65 CYFE.'LSE CODE

1I 5 50 UFC

1I CA.UCSE CCt.tt I 71 UFC 1 ;2 c.EFF2,4 mx n LAP:

1 I , 51 1

ADMINISTRATIVE DATA

Taz..71-4:04E I I I

Frir....C.C.:, ; C177 INI...-71,'

I START

T11.1:1 ;4.17`.:1, 1

START

'....4. CIF IS4174V.. 1EW 1 GATT lifim-v 1

;TART ! END

nuE iffrEiv 1 ..,A,EZ. OF INTERVIEW

I

I FIACERFFINT I PriGTO

ENO ' ENO

./12-10.1 :LTA ocs-,srrcti

CORPORATION DATA

74 M`,TRACSOR NU49E.' I 75 FED SCAV4PRI) / 1 76 C:ARNIA Iraq NAME

, ! 4 7'5

r 7 -.;:y? A:-...s • 1 CORP S.:171 i - Cr...CP 57 ' 11 MRP rri i 31 CCP' :::P C,.-YE

;75 15

:C..' C...":67.-+.;CT S Li /A 5E3 -- :

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COMMANDER'S REPORT OF APO AE 09375

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