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CENTCOM 005313

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TF Band of BrothersForeign Claims Cover Sheet

File #: 6-IR8-587 /

Date Received: II Atl11 ctJ Date of Incident: d-- oC!.f- '1;)})

Claim Amount: 2~ Location: .$qt'"'\A.'Y""C

q73 fI1jl LO (ece,vu!

di(lQ) MrlL- Ull11 did. f! {) ~fe~ uRI\ h!l

DEPARTMENT OF THE ARMYOFFICE OF THE STAFF JUDGE ADVOCATE

HEADQUARTERS, 101ST AIRBORNE DIVISION (AIR ASSAULnOPERATION IRAQI FREEDOM, COB SPEICHER

TIKRfT, IRAQ APO AE 09393

AFZB-JA-C

MEMORANDUM FOR Record

SUBJECT: Claimant Denial

I. This is in response to your claim against the United States Government. Your claim has beenreviewed under the Foreign Claims Act, 10 U.S.c. 2734, as implemented by Army Regulation27-20, Chapter 10. I regret to inform you that your claim has been denied.

2. Your claim has been denied for the following reasons:

a. There is not enough evidence to prove your claim.

b. The evidence shows that United States Forces did not cause the damage.

Q The evidence shows that the damage was caused during combat.d. The evidence shows that the damage was caused by your own negligence or wrongdoing.

e. The evidence shows that your claim was fraudulent.

f. Other: _

3. If this is the first time your claim has been viewed by this office, you may submit an appeal.This office must receive the appeal no later than 30 days after receipt of this message. Theappeal must also contain additional evidence supporting your claim. If the appeal is sent after 30days have passed, or does not provide additional evidence, then the appeal will be denied.

4. POC is the 101st Airborne Division (Air Assault) Claims Office at DSN

CPT,JAChief of Claims

CENTCOM 005316

(b)(6), (b)(3)

(b)(2)High

AFZB-JA-C

DEPARTMENT OF THE ARMYHEADQUARTERS, iot" AIRBORNE DNISION (AIR ASSAULT)

TASK FORCE BAND OF BROTHERSCOB SPEICHER, IRAQ APO AE 09393

14 April 2006

MEMORANDUM OF OPINION

SUBJECT: Claim of 6-IR8-587

I. Identifying Data: Samarra, Iraq

2. Date and place the incident occurred giving rise to the claim: The claim occurred on 02October 2005, in Samarra, Iraq.

3. Amount of claim and date it was filed: Claimant filed a claim for $2,5000n II April 2006.

4. Jurisdiction: This request is presented for consideration under the provisions of the ForeignClaims Act, 10 USC Section 2734, as implemented by Chapter 10, Army Regulation 27-20. Thisclaim was filed in a timely manner.

5. Facts: Claimant alleges that a Coalition Forces shot and killed his son during a battle withAIF. The claimant provided a death certificate and witness statements to substantiate the claim.

6. Opinion: The evidence shows that the damage was caused during combat. This claim is non-compensable under the FCA.

7. Recommendation: The claim is denied.

CPT, JAFCC

CENTCOM 005317

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(b)(6)

(b)(6)

TF Band of Brothers Claims Intake Form

To: United States 昆退ߠ

From: ~;me: Π⤂灲ߠ ِ縇~f  쁥݀攇⸃܀渇ڐ -,- _Decedents: ˠ㨊偲ߠ搄ꀮ /

Hometown: 0 Iraqi Resident: _

(Country)~

Year

My claim arose at: ~_="""'_"~.£l

List in detail the amount of property damage and itemized expenses resulting from the propertydamage or personal injury: (Attach bills and receipts, if applicable.)Item Amount

Total: Z~•

I claim as damages: (Indicate amount in U.S. dollars and local currency)$ Zp.SO-O-= local _

(Signature of Claiman

Subscribed before me this·ll.- day of Afr,1 ,200b.

CENTCOM 005319

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'i""- - -: "...

., State ment of wittness ( ) lives in Sammara ministery ofinteror employed says that

In 1110/20051 was in my duty in sammara ereaat 2:00 at that time therewere a wedding party and they were shooting in the air and there werean american patrol they heard the shoting and open fire randimly .Weknows that there is alittle girl inquired and there is abig wond in herhead which led to kill her after they took her to the hospital.

Wittness

the officer

Statement of wittness ( ) lives in Sammara ,IPemployed says that .

In 1110/2005 I was in the cheekpoint in sammara erea when there werea lotof cars croose the cheek point ,it was a wedding party at that timethe American Forces reach the location ,I heard some shooting and Ifound that the Americar open fire randimly which led to hit alittle girlin her head and die.

Wittness

the officer

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CENTCOM 005320

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Page 9 redacted for the following reason:- - - - - - - - - - - - - - - - - - - - -foreign language, (b)(6)

DEPARTMENT OF THE ARMYOFFICE OF THE STAFF JUDGE ADVOCATE

HEADQUARTERS, 101ST AIRBORNE DIVISION (AIR ASSAULT)OPERATION IRAQI FREEDOM, COB SPEICHER

TIKRIT, IRAQ APO AE 09393

AFZB-JA-C

MEMORANDUM FOR RECORD

SUBJECT: Waiver of Notification

I. I, the Claimant, hereby agree that if I fail to provide any requested evidence to the CMOCClaims Office within sixty (60) days of the date below or to request a written extension of thesixty (60) day period, such inaction shall constitute an affirmative act of abandonment of myclaim, and my claim shall be administratively closed in accordance with the provisions of DAPAM 27-162, paragraph 13-3(1).

2. I further agree that if! wait longer than sixty (60) days from the date below to return to theCMOC to receive notification of the final disposition of my claim or to request a writtenextension of the sixty (60) days period, this failure will result in denial of the claim. The claimwill be administratively closed in accordance with the guidance above.

(60 )iolA SJI..i.(~)

Claimant SignatUҐ縇ΠⰃ끓Π縃뀻ΰ㨇ߠ縇 Sworn before , on \ \ day of :Mf~\,200£.

CENTCOM 005322

(b)(6)

Page 11 redacted for the following reason:- - - - - - - - - - - - - - - - - - - - -foreign language, (b)(6)

"

! " ,

Claims Form

..-._---- ---) NOI;\11 in..urur) Not ~ sub 'ogee

To: t:niled State: Army Forcij, I Claims Commission.Fr0111 N~l11e:_ .. ⸀まˠ✆ߠ 尀ߠ _

ߠ Ƞ∇ˀⰂ쀮ˠ Address: 縀ߠ _

J ~111a. ,\ citizen and n.uiona) of:__.,-'-...L==+- _b. ,\ »cnnancnt rc: dent of:

-~_=-O__oP">"""'-__c. E ·.lployed by: .... -r-r-__d. C cck one ( ) r. , 1Il:;urcr (c. C cck one ( ) J' subrogee (

I hereby make a ..bil11 againsl IC United Siaies Government fo" d'lfll;J.;es 0" injuriesC;llI:-:~·.1 by: (N:1I1C. Ort.:;llliz;lli'·Il, Milit.uy J)CP:lI"{lllCI1{, I\ddrc:::;, Tclc.ihonc Number)

..-J..L..5 Ax V'" j -------- -----.--,-.-

The properly da""'gcd is own'.,! by: (If the claim is m.Jc a:; an ;Igent, parent, or L;u:Jrdi;lIl.aU;}';' 1 a power cf attorney or other evidence or ;\Ul!tori.)' and fill ill Ih\. form below forpari', suxt.iiuiru: ihc d;lIlla~~C 01 illjuri..:s.)

. .> .... -------------_.._--- ._----------

,I I

I\'ly claim arose :111: ocot..{\·101l1!l

Ci\':- a brier slal:"lIlClll or the a. cidcnt or incident Oil \V iicl: the claim r')r (\;II11:IJ..:,C:; topro!',:rly or for l':rs0I1;11 injur, is b:J"ed. (Usc hack of e,i:; sheet ifnccrss.uy.)

-1:-.... -+l.:c--a1~-

Pages 13 through 16 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Foreign Languageforeign language

Al-Duluyeha InvestigationCourt

SUB/ Damage reoprt

Claimant: 縀׀ "-.

According to the decision taken by the court to evaluate thedanage happened to the claimant as aresult of

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