Summary of Past Human Rights Abuse Form

Summary of Past Human Rights Abuse Instructions for Form Full Name Contact Information (Physical Address, Phone Number, or Other Means of Contacting You Through Another Person) Internet Address Facts Supporting Summary (Date, Location, Description of human rights incident) Identification of Other Witnesses to Human Rights incident Name, Unit or Agency, if known, of Abuser (Including Rank, Position, or other identifying Information) Contact Information, if known, of Perpetrator Do you authorize the release of this Summary to non-governmental organizations (NGO’s), international organizations or foreign governments for the purpose of research or establishing commemorative museums, Pamphlets, or histories of the atrocities suffered by the Iraqi People? Yes No If the answer is yes to the above, do you authorize the release of your name and contact information? Yes No Do you desire to have your Summary sealed in an envelope until it is turned over to the Iraqi Interim Authority? Yes No Back to Human Rights Page