COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of 1111, form, see AR 190-45: the proponent agency is the Provost Marshal General
PRIVACY ACT STATEMENT

AUTHORITY;

Title 10 USC Section 301: Title 5 USC Sedion295t; E.O. 9397 dated November 22,1943

PRINCIPAl:

To provide commandef3 and raw enforcement offidals with means by which information may be &CClJralely ifjenlifted.
Your SOCial Security Number is used as an additiol\illllaltemale means of identification to facilitate filing and retrieval.
Disclosure of your Social Security Number is voluntary.

ROUTINE USES:
DISCLOSURE.

1. Control Information
hru:

U$ACRC Number:

0489-2Q04-CID056-76341·5H1A

MP Report Number: N/A

To:

SutHn.tallatfon:

COO2100DC

Referred

Referral Oate:

11119/2004

By:

Suspense Oate:

e hIS! Lieuterlilfl: ~Ionel" the chain of command IS responstble and ileeountable r complehng
arm 48 with support documentatlon
(copies of Article ISs, eoul1-martial orders. reprimilncls, etc) fa( an USACIDC investigations. The unit and brigade commander 01 their equivalenl will
also receive a copy of the DA FOOIl 4833 for all USAC10C investigation,.
COmpany. tIOOP. IiInd battery level commanders are responsible and accountable for completing DA Form 4833 with supporting documentation in "M
~ses investigated by MPI, civilian detectiVes employed by the Department of the Army, and the PMQ. Ac:cur.Jte and complete OA 4833 dispositiol'l
reports are required to meet ilstaUaUon. CO/1'WT'IIiInd. HODA, 000.• nd feder" stalulOty reporting requinlments. The data is used to identify a-ime
trends. establish command progr.Jrns in taw enforcement and other activities, and to ensure tl\at resources are m.a6e av.aHable to support
c;ommlilnde~ who must address issues of soldier and family member indiscipline.
In court-martial eases. iii conviction 01 an offense at court-martial may be for iii different, or lesser included offense. list the offense for which the
individual was convlded at court-martial ill the remarlts section_ Provost Ma~hals musl enter Ihe "MP Report Number" (Brodr-l) for air eases relerred
to commanders. ·Sub-Installation- (BIotk-1) is used to enter report number from a civilian law enforcemenl agency police report. etller infOfTllation on
the civilian law enforcement agency (e g_ eivi~all law enforcement agency address) may be enlered in the remarks seclioll.

2. Offender Identification
(b)(B) (b)(7)(C)

E-6 U.S. Army (SSG)

Grade:

Last Name:

First Name:

(b)(B) (b)(7)(C)

Middle Nam

SSN:

Cadency:

Date of Birth:

3. Referral Information
JCommander Decision Date:

No.

I

1111912004

Offense

Basis

Date

Sexual

Action Taken

Reason

Harassment

1 Premeditated Murder (SH1AI

UCMJ
Artide 118

113/2004

2 Aggravated AssauR {SC1D]

UCMJ
Article 128

1/312004

3 Mlklng a False 5tatemenl!SM3Aj

4

SlQn·11IQ a False Slalemenl15M3C}

UCW

1/312004

Article 107

UCW

111412004

Article 107

5

Obstruction of JustICe [5X51

UCW

1I3l2OO4

Article 134

OA Form 4833 (electronic format), March 2008

N00

VesD

No

IZI Y"D

Noli]

VesD

No0 Y"D

N00

n'D

NOf2]

Y"D

No0

Y"D

N00

Ves0

b(6), b(7)(C)

YeslZ!

NoD ~ccePted

VesD

IOther

peclined Without Explanation

cfll1ed Wtthoul Explanation

NoD ~"d

uuu"JJ
Page

1

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6

ACLU DETAINEE DEATH 2 CID 1489

3. Referrallnfonnation (continued)

No.

Offense

I 6 JASSessory After The Fad

15X4!

Basis

Date

UCMJ

11312004

Sexual
Harassment

Article 78

7 Conspiracy (5X1j

UCMJ

11312004

Article 81

8

VnO

No 121 VnO

VnO

Nol2I

Yes

NoD

VnO

NoD

VnO

NoD

VnO

NOD

YesO

NoD

Yes

0

NoD

Yes

9
10

Action Taken

0

0

Reason

,

N00

N00

rosecution Decline010ther

NOTE: For each offense marked NO for adion taken, you must supply a r9lson.

I! you selecled "YES" for any offense, continue to "Aclion Taken" (Block",,), If you selecled "NO" for ALL offenses, go diredly to ·Commander's
Remarks" (Block--l0), sign, date, and return the form to the agent specified in "Referred By" (8Iock-1).
4. Action Taken

o Non.Judicial (Article 15)

OAdmlnlstrative
Non-Adverse Referrals

(see details below)

o Judicial
Court Martial or Civilian Crillinal Court

Adverse Personnel Actions

Non..Judicial Punishment Authority (select one):

o Summarized
o Company Grade
o Field Grade
o Principal Assistant

o
o

Judicial Punishment Authority (select one):

o
o
o

GCMCA Imposed
General Officer Imposed

Summary Court Martial
Special Court Martial

o General Court Martial

Civilian CriminallMagislrale

I

I

5. NJPfCourt-MartiallClvilian Criminal Court Proceeding Outcome

No.

,

Charged Offense
Murder· Premeditation -Shooting 15H1A]

2 NO ACTION TAKEN

3

N

Finding Offense

Trial
Finding

N

urder - Premeditation -Shooting 15H1Aj

Assaull[5C10j

NO ACTION TAKEN - Making a False St.-tement{5M3A]

• NO ACTION TAKEN

,

A!Nra\/at~

Plea

Signing II False Statement (5M3C

Obstruction of Justice -Person Offenses [5X5j

N

N

5-bstructiCJn 01 Justiee -Person Offenses [5X5j

PLEA: G:Guilty, C:No Contest, N:Nol GuHty. O"'Pre·Tnal DNerSlon, TRtAL FINDING: OCV"'Dismissed (Civil). DCR=Oismissed (Criminal).
P"'Finding for Plaintiff, F:Finding lor Respondei'll. G:Guilly, C:No Contest, N:Nol GUilty, S::Settlement

000004
OA FORn 4833 (electronic format), March 2008

Page 2

of

6

ACLU DETAINEE DEATH 2 CID 1490

5. NJP/Court-MartiallCivilian Criminal Court Proceeding Outcome (continued)

No.

,

Charged Offense
NO ACTION TAKEN

Plea

Finding Offense

Trial
Finding

Assessory After The Fact [5X4]

7 NO ACTION TAKEN - Conspiracy !5Xl]

8

,
10

PLEA: G"'Guilly, C:No Conlest, N=Not Guilty, O.. Pre-Trial Diversion, TRIAL FINDING: DCV-Dlsmissed (Civ~l, DCR=Oismissed (Criminal),
P:Finding tot Plaintiff, F-Finding for Respondent, G=Guilty, C-No Contest, N"'NOI Guilty, S:SettJement

6. Administrative Actions
Non-Adverse
Referred

Agency

Responded

Date Imposed

Family Advocacy

Type of Action

Drug/Alcohol Abuse
Special Referral

1C0unsetingIConcern
Reprimand

Equal Opportunity

Censure
[,G.dmonition

Legal Office

"""0

Written
local OMPF

0
0
0

0
0
0
0

0
0
0
0

Mental Health
Relief Agency
Adverse
Date Imposed

I

Description

IWithholding of Privileges
Adverse Performance Evaluation (OER/NCOERJAcademic Report)
Relief for Cause (OERINCOER)
Mandatory Reassignment
Transfer (such as rehabilitative)
IAdverse Record Entry· Flag
Denial of Reenlistment

Of

Continued Service

--Wthholding of Promotion
Delay of Promotion
Promotion Revocation
Clearance Revocation
Control Roster (downgrade of clearance, PRP reclassification)
Resignation
Retirement
Retirement at lower Grade

From:
To:

ransferto Inactive Reserve

OOOOOJ
OA Form 4833 (electronic format), March 2008

Page 3 of

6

ACLU DETAINEE DEATH 2 CID 1491

6. Administrative Actions (continued)

Date Imposed

Description

Military Occupational Specialty Reclassification
Debarment

Duration:

Job Termination
Job Suspension

Duration:

Leave Vlfilhout Pay

Duration:

o Days o Months o Years
DDays o Months
o Years
o Days o Months o Years

loss of Warrant
IVoIuntary Disclosure
Restitution (to US Government)

Amount:

Restitution (to third party Non-US Government)
Civil·Civil Action Initiation

Amount:

Other (return to states, etc.)
Contract Suspension

Duration:

o Days o Months

DYears

Contract Termination
Amount:

Cost Adjustment
Bid Rejection
Recoupment

Amount :

Denial of Continuatiorl
lUther Contract Action

7. Details of Administrative Separation
Date Imposed
Regulation
Chapter
Characterization
Effective Date
Proceed to Commander's Remarks (BIock-10) jf you chose Administrative Action

8. Non-JudicialiJudicial Sanctions
Sanction

Date Adjudged
Fine

Amount:

Forfeiture

Amount:

Extra Duty

Days:

Restriction

Days:

Correctional Custody

Days:

Confinement

Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge

Effective Date:

Reduction in Grade

Duration:

DDays

o Months o Years

DUfe

o Months o Years
o Months o Years
o Months o Years

Dlife

Front:
To:
Duration:

DDays

Duration:
:Special Assignment
otal Forfeiture (all pay/allowance)Duration :

DOays

Probation

o Days o Months

DDays

Death
Civil Recovery

Amount:

Civil Award

Amount:

UU LJ'UU"ti
DA Fonn 4833 (electronic fonnat), March 2008

Page 4

of

6

ACLU DETAINEE DEATH 2 CID 1492

9. Suspended Sanctions
Were Any Sanctions Suspended?

0

No
DYes
Jf no sanctions were suspended, proceed to MCommander's Remarks" (BJock-10)
Suspended
Sanction

Suspended sanctIon Information
Date Suspended:

Fine

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

FOffeitu Il!'

Date Suspended:

Suspension Duration:

Suspended Portion USS:

Suspended Portion Time:

Suspension Condit)ons:
Date Suspended:
Extra Duty

Suspension Duration:

Suspended Portion TIme:
Suspension Conditions:
Date Suspended:

Restriction

Suspension Duration:

Suspended Portion TIme:
Suspension Conditions:
Date Suspended:

Correctional
Custody

Suspended Portioo TIme:
Suspension Conditions:
Date Suspended:

Confinement

Suspension Duration:

Suspension Duralion:

Suspended Portion Time:
Suspension Conditions:

Reduction in
Grade

Date Suspended:
Suspension Conditions:
Date Suspended:

Probation

Suspension Conditions:
Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Civit Recovery

Suspension Duration:

Suspended Portion Time:
Dale Suspended:

Total
Forfeiture

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Special
Assignment

Suspension Duration:

Suspension Duration:

Suspended Portion USS:
Suspension Conditions:
Date Suspended:

Civil Award

Suspension Duration:

Suspended Portion USS:
Suspension Conditions:

00000'/
DA Form 4833 (electronic format), March 2008

Page 5 of

6

ACLU DETAINEE DEATH 2 CID 1493

10. Commander's Remarks

USA$CRC Number:

0489-2004-CID056-76341-5H1A

Sanction:

A2 2004/11/19

11. Commanding Officer
Was a DNA sample collecte<l from the offender?

DYes

ONo

Name and Grade:
Signature:

ISlgnature Date: 11/1912004

AKO e-Mail Address:

DA Form 4833 (electronic format), March 2008

000008
Page

6 of

6

ACLU DETAINEE DEATH 2 CID 1494

COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form. see AR 1!l().45: the proponent agency is tI'Ie Provost Mal1lMl General
PRIVACY ACT STATEMENT

AUTHORITY:
PRINCIPAl;
ROUTINE USES:
DISCLOSURE:

TnJe 10 USC Se<:tion 301; nle 5 USC Section 2951; E.O. 9397 dated November 22. 1943
To provide commanders .nd law enforcement olfici.1's with means by which information may be accuratety identified.
Your Social Security Number is used as an addtionalfaltemale means of identification to facilitate fiftng and retrieval.
Disclosure of YOUf Social Security Number Is voluntary.

1. Controllnfonnation
Thru:

USACRC Number:

0489·2004·C I0056-76341·5H1 A

MP Report Number: NlA

To:

Sub-Installation:

ReferT&d

11/19/2004

I"efemol Dat"

By:

COO2100DC

I

Suspense Date:

~ first Lieulenanl Colonel in the ctlilin of command is responsible and accountable

r completing II, Form 4833 with support documentation
(copies of Article 15•. coun-manial orders, reprimands, elc) for all USACIDC investigations. Tile unit and brigitde commander or their equivalent
also receive a copy of the DA FOITTl 4833 for aU USACIOC investigations.

wi'

Company, troop, and battery level commander1; are responsible and accountable for completing DA FOITTl 4833 with supporting documentation in all
cases investigated by MPI, dvilian detectives employed by the Department of the Army, and the PMQ. Accurate afld complete DA 4833 disposition
reports aTe required to meet installation, command, HQDA, DOD, and federal statutory reporting requirements. The data is llSed to identify crime
trends, establish command programs in law enforcement ilnd other activities, and to ensure that resources are made llvailable to support
commanders who must address issues of soldier and family member indiscipline.
In court·martial cases, a conviction of an offense at court-martial may be for a different, or lesser inclUded offense. List the offense for which the
individual was convicted al court-martial in the remarks section. Provost Marshals must enter lhe"MP Report Number" (Blodl-1) lor an eases referred
to commanders. "Sub-lnslal1ationw (BIoek-1) is used to entM report number from a civilian law enforcement agency poIloe report. Other intonn.llon 0l'I
the dviHan law enlOleement agency (e.9. civilian lllwenforcement agency address) may be enlered in the IVmarks section.

2. Offender Identification
(b)(6) (b)(7)(C)

Grade:

Last Name:

E·3 U.S. Army (PFC)

First Name:

(b)(6) (b)(7)(C)

Middle Name

SSN:

Cadency:

Oate of Birth:

3. Referral Information
ICommander Decision Oate:

No.
1

Offense

\Making a False Statement (5M3A]

Basis

Da..

UCMJ

11312004

Article 107

2 Obstructeon of Justice (5X5]

I-;- IAssessory Mer The Fact (5X4)
4

I

11/1912004

Conspiracy j5X1 J

UCMJ

11312004

Artide134
UCMJ
Article 78

11312004

UCMJ
Article 81

11312004

5

Sexual
Harassment
VesO

N00

Action Taken

Y~D

Reason

rosecution DeQned/Other
No0
r05eCUbon De .

Y~D

No0

Y~D

Nol2]

vesD

N00

vesD

No0fOtt.er

vesD

No 12]

VesD

No0

Y~D

NoD

Yes

0

"

rosecution DedinedlOtller

NoD
(J(JvJV::J

DA Fonn

.833

(electronIc fonnat), March

2008

b(6), b(7)(C)

Page 1 of

6

ACLU DETAINEE DEATH 2 CID 1495

3. Referrallnfonnation (continued)

No.

Offense

Basis

Date

Sexual
Harassment

•
7

8
9

YesO

NoD

YesO

Y~D

NoD

Yes

Y~D

NoD

Y~D

NoD

Yes

0

NoD

NoD

Y~D

NoD

Yes

'0

Action Taken

0

YesO

0

Reason

NoD
NoD
NoD

NOTE: For each offense marked NO lor actionlaken, YOli musl supply a reason.
If you selected ''YES" for any offense, continue to "Action Taken" (81ock-4). If you selected "NO' for All offenses. go directly to 'Commander's

Remarks" (8Iock.-10), sign, date, and relllm the form to the agent specifloed in "Referred 8y" (8Iock..1).

4, Action Taken

o Administrative

o

o Non.Judicial (Article 15)

Nco-Adverse Referrals

(see details below)

Judicial
Court Martial or Civilian Criminal Court

Adverse PersOflnel Adions

Non.Judlcial Punishment Authority (select one):

o Summarized
o Company Grade
o Field Grade
o Principal Assistant

o
o

GCMCA Imposed
General Officer Imposed

Judicial Punishment Authority (select one):

o Summary Court Martial o General Court Martial
o Special Court Martial
o Civilian CriminalfMagistrate
I

I

5. NJP/Court·Martial/Clvilian Criminal Court Proceeding Outcome

No.

Charged Offense

1

NO ACTION TAKEN - Making a False Statement (5M3A)

Plea

Finding Offense

Trial
Finding

2 NO ACTION TAKEN - ObstrtJdicn 01 Justice (5X51

3 NO ACTION TAKEN

•

AssesSOl'Y Aller The Fad [5X4J

NO AcnON TAKEN - Conspifacy [5X11

5

PlEA: G:Guilty, C:No Contest, N"Not GUilty, D:Pre-Trial Diversion, TRIAL FINDING: OCV:Di5misslld (Civil), DCR=Oismissed (Criminal),
paFinding for Plaintiff, F:Finding for Respondent, G:Guilty, C:No Contest, N.Not Guilty, S=Settlement

OA Fonn 4833 (electronic fonnat), March 2008

000010
Page

2

of

6

ACLU DETAINEE DEATH 2 CID 1496

5. NJP/Court-MartiaUCivllian Criminal Court Proceeding Outcome (continued)

No.

Charged Offense

Plea

Finding Offense

Trial
Finding

,
7

•
9

,.
PLEA: G=Guitty, CaNo Conies\, N"'NDt Guilty. O;Pre·Trial Oiversion, TRIAl FINDING: OCV"Dismissec! (Civil), DCR-Oismissed (Criminal).
P-Flnding for Plaintiff, FcFinding for Responoenl, G=Guilty. C;No Contest, N=Not Guilty, S-Settlemenf

6. Administrative Actions
Non-Adverse
Referred

Agency

Responded

Date Imposed

Family Advocacy
~ruglAiCOholAbuse

0 ..,

Type of Action

-teounselingIConcem

pecial Referral

Reprimand

Equal Opportunity

lCensure

legal Office

Admonition

Written

Local OMPF

0
0
0
0

0
0
0
0

0
0
0
0

Mental Health
Relief Agency
Adverse

Date Imposed I

Description

~hholding of Privileges
Adverse Performance Evaluation (OERINCOER/Academic Report)
Relief for Cause (OER/NCOER)
Mandatory Reassignment
~sfer (such as rehabilitative)

erse Record Entry. Flag
Denial of Reenlistment or Continued Service
'Nithholding of Promotion
Delay of Promotion
Promotion Revocation
Clearance Revocation
Control Roster (downgrade of clearance. PRP reclassification)
Resignation
Retirement
Retirement at lower Grade

From:
To:

ransfer to Inactive Reserve

000011
Page

OA Form -4833 (electronic fonnat), March 2008

3 of

6

•

ACLU DETAINEE DEATH 2 CID 1497

6. Administrative Actions (continued)
Date Imposed

Description
Military Occupational Specialty Reclassification
Debarment

Duralion:

Job Termination
Job Suspension

Duration:

Leave VJithout Pay

Duration:

o Days o Months
o Days o Months

o Years
o Years
o Years

o Days o Months

DYears

DDays

DMonths

Loss of Warrant
Voluntary Disclosure
Restitution (to US Government)

Amount:

Restitution (to third party Non-US Government)
Civil-Civil Action Initiation

Amount:

Olher (retLlffl to slates, elc.)
Contract Suspension

Duration:

Contract Termination

Amount:

Cost Adjustment
Bid Rejection
Recoupment

Amount:

Denial of Continuation
Other Contract Action
7. Details of Administrative Separation
Date Imposed
Regulation
Chapter
Characterization
Effective Date
Proceed to Commander's Remarks (Block.1 0) if you chose Administrative Action
8. Non-Judicial/Judicial Sanctions
Date Adjudged

Sanction
Fine

Amount:

Forfeiture

Amount:

Extra Duty

Days:

Restriction

Days:

Correctional Custody

Days:

Confinement

Duration:

Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge
Reduction in Grade

Effective Date:
From:

DDays

To:
Probation

Duration:

Duration:
Special Assignment
Total Forfeiture (all paylaliowance)Duration:

.

o Days o Months

o Months o Years

o Days
o Days

o Months

DDays

DMonths

DMonths

DUfe

DVears

o Years
o Years

DUfe

Death
Civil Recovery

Amount:

Civil Award

Amount:

DA Fonn 4833 (electronIc Jonnat), March 2008

OOO"QJ ~

of

6

ACLU DETAINEE DEATH 2 CID 1498

9. Suspended Sanctions
Were Arly Sanctions Suspended?

If no

DYes
0No
sanctions were suspended, proceed to -Commander's Remar1ts· (BIock-10)

Suspended
Sanction

Suspended Sanction Infonnation
Date Suspended:

Fine

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

Forfeiture

Date Suspended:

Suspension Duration:

Suspended Portion US$:

Suspended Portion Time:

Suspension Conditions:
Date Suspended:
Extra Duty

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Restriction

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Correctional
Custody

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Confinement

Suspension Duration:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Reduction in
Grade

Date Suspended:
Suspension Conditions:
Date Suspended:

Probation

Suspension Duration:
Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Special
Assignment

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Total
Forfeiture

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Civil Recovery

Suspension Duration:

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:
Date Suspended:

Civil Award

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

000013
OA Fonn 4833 (electronic fonnat), March 2008

Page 5

of

6

ACLU DETAINEE DEATH 2 CID 1499

10. Commander's Remarks

0489-2004-CI D056-76341 ~5H 1A

USASCRC Number:

Sanction:

F12004/11/19

11. Commanding Officer
Was a DNA sample collected from the offender?
Name and Grade:

DYes

ONo

,

/signawre:

"lSTgnature Date: 11/19f2004

\AKO e-Mail Address:

DA Forrn4833 (electronic fonnal), March 2008

6

ACLU DETAINEE DEATH 2 CID 1500

COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form, see AR 190-45; the proponent agency is the Provost Marshal General
PRIVACY ACT STATEMENT
Title 10 USC Sedion 301; Title 5 USC Section 2951; E.O. 9397 dated November 22, 1943
To provide commanders and faw enforcement official! with means by which information may be accurately identified.
YOllr Social security Number is used as an additionatfallernate means of identification to facilitate filing and retrieval.
Disclosure of your Social Security Number is voluntary.

AUTHORITY:
PRINCIPAL:
ROUTINE USES:
DISCLOSURE:

1. Control Information
Thru:

USACRC Number:

0489-2004-C I0056·76341·5H 1A

MP Report Number: N/A
To:

Sub·lnstallation:

COO2100DC

Referred

Referral Date:

1111912004

By:

Suspense Date:

The !Ifst

lieulenan~

IJolonelln the chain 01 command Is responsible al'ld accountable lor completing.uA

~orm

4833 with support documentatIOn
(copies of ArtiCle 15s, court-martial orders, reprimands, etc] for all USACIOC investigations. The unit and brigade commander or their equfvalent will
also receive a copy of the OA Form 4833 for all USACIDC investigations.
Company, troop, and battery level commanders are responsible alld accountable for completing
cases investigated by MPI, civilian detectives employed by the Department of the Army, and the
reports are required 10 meet installation, command, HQDA, DOD, and federal statutory reporting
trends, establish command programs in law enforcemenl and olher activities, and to erlsure that
commanders who must address issues of soldier and family member lrldlsciplirle.

OA Form 4833 with supporting documentation in all
PMO, ACC\Jrate and complete OA 4833 dispos~ion
requirements. The data is used to identify crime
resources are made available to support

In court-martial cases, a conviction of an offense at court-martial may be for a different, or lesser Induded offense. List the offense for which the
irldivldual was convicted at court-martial in the remarks section. Provost Marshals must enter the "MP Report Number" (Block"l) for all cases referred
to commanders. "Sub-Installation" (Block·1) Is used to enter report number from a civilian law enforcement agency police report. Other informahon on
the civilian law enforcement agency (e.g. civiliarl law enforcement agency address) may be entered in the remarks section.

2. Offender Ide
Last Name:

.

.a•

n

(b)(6) (b)(7)(C)

E-6 U.S. Army (SSG)

Grade:

First Name:
Middle Name:

SSN:

Cadency:

Oate of

3.

(b)(6) (b)(7)
(C)
Birth:

Referral Information

lcommander Decision Oate:

No.

I

11/1912004
Basis

Date

1 Making a False Statemenl (5M3A)

UCMJ
Article 107

1/312004

2 Obslructiorl of Justice [5X5]

UCMJ
Article 134

1I3/20G4

Offense

3

Assessory After The Fact [5X4)

UCMJ
Article 78

11312004

4

Conspiracy [5X1j

UCMJ
Article 81

1/312004

5

Sexual
Harassment
VesD

vesD

vesD

Yes

0

vesD

No0

Action Taken

Yes

0

No/Z]

No0

Yes

0

NolZ]

No0

Yes

0

Noli]

No0

Yes

0

No0

NoD

Yes

0

NoD

Reason

Prosecution Declined/Other

Prosecution DecflrledlOlher

Prosecution Declined/Other

Prosecution Declined/Other

Uv IU1.)
OA Fonn 4833 (electronic fonnat), March 2008

b(6), b(7)(C)

Page

1

of

6

ACLU DETAINEE DEATH 2 CID 1501

3. Referrallnfonnatlon (continued)

No.

Offense

Basis

Date

Sexual
Harassment

6

Yes

0

Action Taken

N,o

VesO

NoD

7

v"o N'o v.. 0

N,o

6

V"O N,o

N'o

9

V"O N,o v.. 0

N'o

10

v.. 0

N,o v.. 0

N'o

YesO

Reason

NOTE: For each offense marked NO lor ilction taken, you muSI ~ppty a reason.
If you selected "YES· tot any offense, continue to "Action Taken" (BIock~). If you seleded "'NO" for All offenses, go directly to "Commander's
Remarks" (Block·101, sign, date, and return the form to the agent specified in ""'Referred By" (BIock-l).

4. Action Taken
OAdmlnismtive
Non-Adverse Referrals

o Non-Judiclal (Article 15)
(see details below)

OJudlcial
Court Martial or Civilian Criminal Cour1

Adverse Personnel Actions

Non-Judicial Punishment Authority (select one):

o Summarized
o Company Grade
o Field Grade
o Principal Assistant

o GCMCA Imposed
o General Officer Imposed

o Summary Court Martial o General Court Martial
o Special Court Martial
o Civilian CriminallMagistrate
I

5. NJP/Court·Martial/Clvilian

No.

Judicial Punishment Authority (select one):

I

Criminal Court Proceeding Outcome

Charged Offense

Plea

Finding Offense

Trial
Finding

1 NO ACTION TAKEN .. Making a False Statement [5M3AJ

2 NO ACTION TAKEN

Obstruction or Justice {5X5J

3 NO ACTION TAKEN _ Assenory After The Fact {5X4J

.

~ACnONTAKEN

Conspiracy (5X1J

5

PLEA: G-Guilty, C-No Contest, N"'Not Guilty. D=Pre. Trial Divel$ion, TRIAl FINDING: DCV-Ossmiued (CMl), DCR"'DismJssed (Criminal),
P=Findiog for Plaintiff, FzFinding for Respondent, G=Guilty, C>No Contest. N=Not Guilty. S-5ettlement

V
OA Form 4833 (electronic format), March 2008

'U.l '
Page 2

of

6

ACLU DETAINEE DEATH 2 CID 1502

5. NJP/Court-MartiaUCivilian Criminal Court Proceeding Outcome (continued)
No.

Charged Offense

Plea

Finding Offense

Trial
Finding

6

7

•
•
10

PLEA: G:Guilty, C=No Contest, N=Not Guilty, D=Pre- Trial Diversion. TRIAL FINDING: DCV=DismiSsed (CivM). OCR-DiSmissed (eminal),
P5Finding for Plaintitr, F"Findiog fOf Respondef1t, G=Guilty. C=No Contest N::NQt Guilty. S"Setuement

6. Administrative Actions
Non·Adverse
Agency

Referred

Responded
Date Imposed

Family Advocacy
~rugiAICOhOI Abuse

Type of Action

0,,1

Counseling/Concern

0
0
0
0

pecial Referral

Reprimand

Equal Opportunity

ensure
Admonition

egalOffice

WrItten
Local OMPF

0
0
0
0

0
0
0
0

lMental Health
IRelief Agency
Adverse
Description

Date Imposed

Withholding of Privileges
Adverse Performance Evaluation (OERlNCOER/Academic Report)
Relief for Cause (OER/NCOER)
Mandatory Reassignment
Transfer (such as rehabilitative)
IAdverse Record Entry· Flag
tnial of Reenlistment or Continued Service
ithholding of Promotion

Delay of Promotion
Promotion Revocation
Clearance Revocation
Control Roster (downgrade of clearance, PRP redassificalion)
Resignation
Retirement
Retirement at Lower Grade

From:
To:

Transfer to Inactive Reserve

000017
DA Fonn 4833 (electronic tonnat). March 2008

Page 3 of

6

ACLU DETAINEE DEATH 2 CID 1503

6. Administrative Actions (continued)
Date Imposed

Description
Military Occupational Specialty Redassification
Debarment

Duration:

ob Termination
Job Suspension

Duration:

leave Without Pay
loss of Warrant

Duration:

o Days o Months o Years
o Days o Months o Years
o Days OMonlhs DYears

oIunlary Disclosure
Reslilution (to US Government)

Amount:

Restitution (to third party Non-US Government)
Civil-Civil Action lomation

Amount:

Other (return to states, etc.)
Contract Suspension

Duration:

OOays

o Months o Years

Contract Termination
Cost Adjustment

Amount:

Bid Rejection
Recoupment

Amount:

Denial of Continuation
Other Contract Action
7. Details of Administrative Separation
Date Imposed
Regulation
Chapter
Characterization
Effective Date
Proceet:l to Commande(s Remar\(s (Block·10) if you chose Administrative Action
8. Non-Judicial/Judlciaf Sanctions
Sanction

Date Adjudged
Fine

Amount:

Forfeiture

Amount:

ExIra Duty

Days:

Restriction

Days:

Correctional Custody

Days:

Confinement

Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge

Effective Date:
From:

Reduction in Grade

To:
Probation

Duration:

Special Assignment

Duration:

etal Forfeiture (an pay/allowance)DtKation :

Duration:

DOays

o Days

o Monlhs o Years

o Days
o Days
o Days

o Months o Years
DMonths o Years
DMonths

o

Years

o Months
Olif.

DUfe

Death
~ivil Recovery

Amount:

ivil Award

Amount:

DA Fonn 4833 (eleetronlc fonnat), March 2008

6

ACLU DETAINEE DEATH 2 CID 1504

9. Suspended Sanctions
Were Any Sanctions Suspended? DYes
0No
If no sanctions were suspended, proceed to ·Commander's Remarks· (Blodt:.10)
Suspended
Sanction

Suspended Sanction Information
Date Suspended:

Fine

Suspension Duration:

Suspended Portion USS:
Suspension Conditions:

Forfeiture

Date Suspended:

Suspension Duration:

Suspended Portion USS:

Suspended Portion TIme:

Suspension Conditions:
Extra Duty

Dafe Suspended:
Suspended Portion Time:

Suspension Duration:

Suspension Conditions:
Dale Suspended:
Restriction

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Correctional
Custody

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Dale Suspended:

Confinement

Suspension Duration:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Reduction in
Grade
Probation

Date Suspended:
Suspension Conditions:

Suspension Duration:

Date Suspended:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Spedsl
Assignment

Tolal
Forfeiture

Suspended Portion TIme:
Suspension Conditions:
Dale Suspended:
Suspended Portion Time:

Suspension Duration:

Suspension Conditions:
Date Suspended:

Civil Recovery

Suspension Duration:

Suspension Duration:

Suspended Portion USS:
Suspension Conditions:
Date Suspended:

Civij Award

Suspension Duration:

Suspended Portion USS:
Suspension Conditions:

00001.1
DA Form 4833 (electronic format), March 2008

Page

5

of

6

ACLU DETAINEE DEATH 2 CID 1505

10. Commander's Remarks

04BS·2004·CID056· 76341·5H 1A

USASCRC Number:

Sanction:

F52004111119

11. Commanding Officer
was a DNA sample collected from the offender?

Name and Grade:

DYes

ONo

•

Is'ignature:

lSTgnature Date: 11/1912004

AKO e-Mail Address:

DA Form 4833 (electronic format). March 2008

oD002'

Page 6 of

6

ACLU DETAINEE DEATH 2 CID 1506

COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form, see AR 190-45: Ihe proponent agency is the Provost Marshal General
PRIVACY ACT STATEMENT
AUTHORITY;

PRINCIPAL:
ROUTINE USES:
DiSCLOSURE:

TiUe 10 USC Sealon 301: TJlle 5 USC Section 2951; E,O. 9397 dated November 22, 1943
To provide commanders and law enforcemer.t officials with means by which information may be accurately identified.
Your Social Security Numbltt is used as 1I1'l additional/alternate means of identification to facilitate filing and retrieval.
Disclosure of your Social Security Number is vohmtary.

1. Control Information
Thru:

0489-2004-C I0056-76341-5H 1A

USACRC Number:

MP Report Number: N/A

To:

Sub-Installation:

COO2100DC

Referred
By:

Referral Date:

11/19/2004

Suspense OaOO:

I he first Lieutenant Colonel in the ensin 01 command \s responsible and accountable for completing. uA rorm 4833 with support documentation
{copies 01 Article 15s, court-mllrtial orclers, reprimands, etc) for atl USACIOC investigations. The unit and brigad$ commander or their equivalt'nt will
also receive a copy of the DA Form 483Jlor all USACIDC investigations.
Company, troop, and battery level commanders are responsible and accountable for completing DA Form 4833 with supporting do-cumenlation in ali
cases investigated by MP1, civilian detectives employee! by the Department of the Army, and the PMQ. Accurate and complete OA 4833 disposition
reports are requirea' to meet instal!ation, command, HQDA, DOD, and federal staMol)' rep.o1tmp requirements. The data is used to idel1tlfy crime
trends, establish command programs in law enforcement aM other activities, and to ensure that resources are made available to support
cornrnanders who must address issues of soldier and family member indiscipline.
In coulf-martial cases, a conviction of an offense at court-martial may be for a different, or lesser included offense. List the offense for which the
individual was convicted at court-martial in the remafll.s section, Provost Marshals must tlnter the "MP Report Number'" (BlociI- f) fur all cases relerrad
to commanders. "Sub-Installation" (BlocJ(-1) is lIsed to er'lter report number from a civilian law enforcemenl agency police report. Other information on
the ciVilian law enforcement agency (e.g. civilian law enforcement agency address) may be entere<l in the remaTks section.

2. Offender Identification
(b)(6) (b)(7)(C)
last Name:

E·'

Grade:

U.S. Army {SPC}

First Name:

(b)(6)
Middle Name:

SSN:

Cadency:

Date of Birth

3. Referral Information
!commander Decision Date:

I

11/1912004

Basis

Date

1 Making a False Statement [5MJA]

UCMJ
Article 107

113/2004

2 Obst!1Jdion of JUstice [5X5J

. UCMJ
Article 134

1/312004

No.

Offense

3

~ssessory After The Fact [5X4]

UCMJ
Article 78

11:312004

,

Conspiracy {5Xlj

UCMJ
Article 81

11312004

5

OA Fonn 4833 (electronic format), March 2008

Sexual
Harassment
Yes

0

vesD

Yes

0

N00

YesO

N00

N00

vesD

N00

V"O

N00

NOrl)

N00 V"O

V"O
Yes

Action Taken

0

NoD

b(6), b(7)(C)

Yes

0

No0

Reason

ProseClJlion Declined/Other

rosecutioll Declined/Other

Proseculion Oedined/Oll)er

Prosecution DecfinedfOther

NoD

OOO<t~L

of

6

ACLU DETAINEE DEATH 2 CID 1507

3. Referral Information (continued)

No.

Offense

Basis

Date

Sexual
Harassment

6

7

8
9
10

Action Taken

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Reason

NOTE: For each offense marked NO for action taken, you must supply a reason.
If you selected "YES" for any offense, continue 10 "Action Taken" (Block",,). If yOll selected "NO' for ALL offenses, go directly to "Commande(s
Remarks~ (Block-l0J, sign, date, and return the form 10 the agent specified in "Referred By" (Block-l).

4.

Action Taken
DAdministrative
Non-Adverse Referrals

o Non-Judicial (Article 15)

DJudlclal
Court Martial or Civilian Criminal Court

(see details below)

Adverse Personnel Actions

Non-Judicial Punishment Authority (select one):

o Summarized
o Company Grade
o Field Grade
o Principal ASSistant
5.

o GCMCA Imposed
o General Officer Imposed

Judicial Punishment Authority (select one):

o Summary Court Martial o General Court Martial
o Special Court Martial
o Civilian CriminallMagistrate
I

I

NJP/Court·Martial/Clvilian Criminal Court Proceeding Outcome

No.
1

Charged Offense
NO ACTION TAKEN -- Making

Plea

Finding Offense

Trial
Finding

a False Stalement [5MJAj

2 NO ACTION TAKEN

Obstruction at Justice [5X5]

3 NO ACTION TAKEN

Assessory After The Fact [5X4]

,
4

NO ACTION TAKEN

Conspiracy 15Xl)

5

PLEA: G=Guilty, C=No Contest, N=Not Guilty. D=Pre-Trial Diversion, TRIAL FINDING: DCV=Oismissed (Civil), DCR"'Dismissed (Criminal).
P=Ffnding for Plaintiff. F=Finding for Respondenl. G=Gvllty, C=No Contest, N=Nol Guilty, S"'Settleme~t

0000-::2
~

DA Fonn 4833 (electronic tonnat), March 2008

Page 2 of

6

ACLU DETAINEE DEATH 2 CID 1508

5. NJP/Court·MartiallCivilian Criminal Court Proceeding Outcome (continued)

No.

Charged Offense

Plea

Finding Offense

Trial
Finding

6

7

8

9

10

PLEA: G"Guilty. C=No Contest, N=Not Guilty, D"Pre·Trial Diversion. TRIAL FINDING: DCV=Dismissed (Civil), DCR=Drsmissed (Criminal).
P=Finc\ing for Plaintiff. F:Finding for Resporodenl. G=Guilty, C"No CoOlest, N"Nol Guilty, S"Settlement

6.

Administrative Actions
Non·Adverse
Referred

Agency

Responded
Date Imposed

Family Advocacy

Written

Type of Actlon

Ono' local OMPF

Drug/Alcohol Abuse

Counseling/Concern

Special Referral

Reprimand

Equal Opportunity

Censure

legal Office

Admonition

0
0
0
0

0
0
0
0

0
0
0
0

Mental Health
Relief Agency
Adverse
Description

Date Imposed

Withholding of Privileges
Adverse Performance Evaluation (OERJNCOERlAcademic Report)
Relief for Cause (OER/NCOER)
Mandatory Reassignment
Transfer (sllch as rehabilitative)
Adverse Record Ent!)' • Flag
Denial of Reenlistment or Continued Service
!Withholding of Promotion
Delay of Promotion
Promotion Revocation
Clearance Revocation
Control Roster (downgrade of clearance, PRP reclassification)
Resignation
Retirement
Retirement at lower Grade

From:
To:

Transfer to Inactive Reserve

000023
DA Fonn 4833 (electronic fonnat), March 2008

Page 3

of

6

ACLU DETAINEE DEATH 2 CID 1509

6. Administrative Actions (continued)
Description

Date Imposed
Military Occupational Specialty Reclassification
Debarment

Duration:

DDays

Job Suspension

Duralion:

DOays

o Months OYears
o Months o Years

Leave Without Pay

Duration:

DOays

OMonths

Job Termination

DYears

Loss of Warrant
Voluntary Oisdosure
Restitution (to US Government)

Amount:

Reslilution (to third party Non·US Government)

Amount:

Civil·Civii Action Initiation
Other (return to states, etc.)
Contract Suspension

Duration:

o Days o Monlhs o Years

Contract Termination
Cost Adjustment

Amount:

Bid Rejection
Amount:

Recoupment
Denial of Continuation
Other Contract Action

7. Details of Administrative Separation
Date Imposed
Regulation
Chapter
Characterization
Effective Date
Proceed to Commanaer's Remarks (Block·10) if you chose Administrative Action

8. Non-JudiciallJudicial Sancfions
Sanction

Date Adjudged
Fine

Amount:

Forfeiture

Amount:

Extra Duty

Days:

Restriction

Days:

Correctional Cuslody

Days:

Duration:

DDays OMonths

DOays

o Months

DYears

Duration:

DDays

DMonths

DYears

Duration:
Special Assignment
Total Forfeiture (all pay/allowance)Duration :

DDays

Confinement

Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge

Effective Date:

Reduction in Grade

o Life

From:
To:

Probation

DDays

o Months o Years
o Months DYears

o life

Death
Civil Recovery

Amount:

Civif Award

AmOlJ1lf :

UUUU.::
DA Fonn 4833 (electronic fonnat), March 2008

Page 4 of

6

ACLU DETAINEE DEATH 2 CID 1510

9. Suspended Sanctions
Were Any Sanctions Suspended?

[{jNo
DYes
If no sanctions were suspended, proceed to "Commander's Rernarks« (SIOck-l0)
Suspended
Sanction

Suspended Sanction Information
Date Suspended:

Fine

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

Forfeiture

Date Suspended:

Suspension Duration:

Suspended Portion US$:

Suspended Portion Time:

Suspension Conditions:
Date Suspended:
Extra Duty

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Restriction

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Correctional
Custody

Confinement

Suspension Duration:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Reduction in
Grade

Date Suspended:
Suspension Conditions:
Date Suspended:

Probation

Suspension Duration:
Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Special
Assignment

Total
Forfeiture

Suspended Portion Time:
Suspension Conditions:
Date Suspended:
Suspended Portion Time:

Suspension Duration:

Suspension Conditions:
Date Suspended:

Civil Recovery

Suspension Duration:

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:
Dale Suspended:

Civil Award

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

DA Form 4833 (electronic format). March 2008

Page 5

of

6

000025
ACLU DETAINEE DEATH 2 CID 1511

10. Commander's Remarks

0489-2004-CID056-76341-5H1 A

USASCRC Number:

Sanction: F52004/11/19

11. Commanding Officer
Was a DNA sample coJJected from the offender?
Name and Grade:

DYes

ONo

,

Signature:

"lSignature Date: 1111912004

IAKO e-Mail Address;

000 U~f:j
OA Form 4833 (electronic fonnat), Marth 2008

Page 6

of

6

ACLU DETAINEE DEATH 2 CID 1512

COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form, see AR 190-45: the proponent agency is the Provost Marshal OMaral
PRIVACY ACT STATEMENT

AUTHORITY:
PRINCIPAL:
ROUTINE USES:

DISCLOSURE:

nle 10 USC Section 301; Title S USC Section 2951; E.O. 9397 dated November 22, 1943
To provide commander5 and Jaw enforcement officials with means by which information may be accurately identified.
Your Social Security Number is used as an eddilionaValtemale means or identification 10 facilitate filing Bild retrieval,
Disclosure of your Social Security Number is voluntary.

1. Control Information
Thru:

U$ACRC Number:

0489-2004-C1D056-76341-5H1 A

MP Report Number: NIA

To:

Sub-Installation:

COO2100DC

Referred
By:

Referral Date:

11/1912004

Suspense Date:

The firSl Lieutenant ....olonel in the chain 01 command is responsible and accountable lor completing A r-orm 4
wilh support documerltatiorl
(copies of Article 155, court-martial orders, reprimands, etc) for all USACIDC irlvestigatiorl5. The unit arlo' brigade commarrder or their equivalent will
also receive a copy of the DA Form 4833 for all USACIDC irlvestigations.
Comp;;lrIy, troop, arlo' battery level commarlders are responsible and accountable for completirlg DA Form 4833 with supporting documlilntation in all
cases investigated by MI:>I. civlliarl detectives employed by the Department of tI1e Army. and the PMO. Accurate arlo' complete DA 4833 disposition
reports are required to meet instalfation, command, liCDA, DOD, and feo'eral statutory reporting reqlJiremenlS. The data is used to identify crime
trends, establish commano' programs in law enforcement and other activities, arlo' to ensure that resources are made available to support
commanders who must address issues of soldier and family member indiscipline.
In court-martial cases, a conviction of i31n offense at court-martial may be for a different, or lener included offense. List the offense for which the
individual was convicted at court-martial in the remalks section. Provost Marsha!$ must enler the "MP AeP'Ofl Numbar" {BJoek-1) for all cases referred
to commanders. "SUb-Installation" (BIOClt-l) is used to enter report number from a civilian iaw enforcement agency police report. Other information on
the civilian law enforcement agency (e.g. civilian law enforcement agency address) may be entered in the remarKs section.
2, Offender Identification
Last Name:

(b)(6) (b)(7)
(C)

£.:5 U.S. Army (SGT)

Grade:

First Name:

(b)(6) (b)(7)(C)

Middle Name:

SSN:

Cadency:

Date of Birth:

3. Referral Information
ICommander Decision Date:

No.

Offense

1 Making a False Statement (5M3A)

2

Obstruction of Justice [5X5}

3

Assessory After The Fact {5X4)

4 Conspiracy {5X I}

I

11/19/2004

Basis

Date

UCMJ

1/3/2004

Micle 107
UCMJ
Article 134

1/'J12004

UCMJ
Article 76

11312004

UCMJ
Article 81

1'JJ2004

5

Sexual
Harassment
vesD

Action laken

No[2J

VesD

0

Yes

0

No0

Yes

Yes

0

N00

Y~D

YesO

Yes

0

0

N00

Yes

NoD

Y~D

Noli]

N00

Reason

rosecution Dec!ined/other

Prosecution Declined/Other

Prosecution Declined/Other
No0

N00

Prosecution Dedined/Other

NoD
•

OOQ2f7

OA Fo"" 4833 (electronic fonnat), March 2008

of

6

b(6), b(7)(C)
ACLU DETAINEE DEATH 2 CID 1513

3. Referral Information (continued)

No.

Offense

Basis

Date

Sexual
Harassment

6

0

NoD

Yes

0

NoD

y"o

NOD

Yes

0

NoD

Yes

7

8
9

10

Action Taken

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NOD

Yes

0

NoD

Reason

NOTE: For each offense marxed NO for action taken, you must supply a reason.
If you selected "YES' for any offense, continue to "Action Taken· (Block-4). If you selected "NO' for All offenses, go directly to "Commander's
Remarks· (Block-l0), sign, date, and return the form to the agent specified in "Referred By" (Block- \).

4. Action Taken

o Administrative

o Non.Judicial (Article 15)

Non-Adverse Referrals

(see details below)

o Judicial
Court Martial or Civilian Crimina! Court

Adverse Personnel Actions

Non.Judicial Punishment Authority (select one):

o Summarized
o Company Grade
o Field Grade
o Principal Assistanl

o GCMCA Imposed
o General Officer imposed

5. NJPfCourt-MartlalfClvillan

No.
1

o General Court Martial

D Summary Court Martial

o
o

Special Court Martial
Civilian CriminallMagistrate

I

I

Criminal Court Proceeding Outcome

Charged Offense
NO ACTION TAKEN

Judicial Punishment Authority (select one):

Plea

Finding Offense

Trial
Finding

Making a False Statement [5M3A)

2 NO ACTION TAKEN - Obstruction of Justice [5X5J

3 NO ACTION TAKEN·- Assessory After The Fact (5X4]

,

•
NO ACTION TAKEN

Conspiracy (5Xl)

5

PLEA: G"Guilty, G=No Contest, N"Not Guilty. D:Pre·Trial Diversion, TRIAL FINDING: DCV=Cismissed (Civil), DGR:Dismissed (Criminal).
P:Finding for Plaintiff, F"Finding for Respondent, G:Guitty, C:No Contest. N=Not Guilty, S=Settiemel1t

OA Fonn 4833 (electronic format), March 2008

Page 2

of

6

000028
ACLU DETAINEE DEATH 2 CID 1514

5. NJP/Court-MartialfCivilian Criminal Court Proceeding Outcome (continued)

No.

Charged Offense

Plea

Finding Offense

Trial
Finding

6

7

,
9

10

PLEA: G:::Guilly, C:::No Contest, N:::Not Guilty, D::Pre-Trial Diversion, TRIAL fiNDING: DCV:::Dfsmissed (Civil), OCR:::Dismissed (Criminal),

P:::Fillding for Plaintiff, F:::Finding fOf Respondent, G::Guilty, C::No Contest, N:::Not Guilty, S=Settlement

6. Administrative Actions
Non-Adverse
Agency

Referred

Responded

Type of Action

0 ..,

Drug/Alcohol Abuse
Special Referral

Counseling/Concern
Reprimand

Equal Opportunity

Censure

Legal Office

lAdmonition

0
0
0
0

Date Imposed

Family Advocacy

Written
Local OMPF

0
0
0
0

0
0
0
0

Mental Health
Relief Agency
Adverse
Date Imposed

Description
Withholding of Privileges
!Adverse Performance Evaluation (OERINCOERIAcademic Report)
Relief for Cause (OERINCOER)
Mandatory Reassignment
!isnSfer (such as rehabilitative)
dverse Record Entry - Flag
Denial of Reenlistment or Continued Service
Withholding of Promotion
Delay of Promotion
Promotion Revocation
Clearance Revocation
Control Roster (downgrade of clearance, PRP reclassification)
Resignation
Retirement
Retirement at Lower Grade

From:
To:

ransfer to Inactive Reserve

000029
OA Fonn 4833 (electronic fonnat), March 2008

Page

3

of

6

ACLU DETAINEE DEATH 2 CID 1515

6. Administrative Actions (continued)

Date Imposed

Description
Military OCcupational Specialty Reclassification
Debarment

o Days o Monlhs
o Days o Months
o Days o Months

Duration:

ob Termination
ob Suspension

Duration:

Leave VlMhoul Pay

Duration:

OVears
OVears
OVears

Loss of Warrant
Voluntary Disclosure
Restitution (to US Government)

Amount:

Restitution (to third party Non-US Government)

Amount:

Civil-Civil Action Initiation
Other (return 10 slates, etc.)
Contract Suspension

o

Duration:

Days

o Months

OVears

Contract Termination
Cost Adjustment

Amount:

Bid Rejection
Amount:

Recoupment
Denial of Continuation

10iher Contract Action

7. Details of Administrative Separation
Date Imposed
Regulation
Chapler
Characterization
Effective Date
Proceed to Commander's Remarks (Btock-l0) if you chose Administrative Action
8. Non-JudiciaUJudicial Sanctions
Sanction

Oate Adjudged
Fine

Amount:

Forfeiture

Amount:

Extra Duty

Days:

Restriction

Days:

Correctional Custody

Days:

Confinement

Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge

Effective Date:

Reduction in Grade

Duration:

o

Days

0

Months

DDays

o Months o Years

o Life

o
o
o

o Months o Years
o Months o Years
o Monlhs DYears

OUfe

From:
To:

Probation

Duration:

Special Assignment

Duration:

Total Forfeiture (all paylalJowance)Duralion :

Days
Days
Days

Death
Civil Recovery

Amount:

Civil Award

Amount:

V
DA Fonn 4833 (electronic fonnat), March 2008

1.1'O'TJ3'"
Page 4 of

6

ACLU DETAINEE DEATH 2 CID 1516

9. Suspended Sanctions
Were Ally Sanctions Suspended?

DYes
0No
If no sanctions were suspended. proceed to -Commander's Remarks" (Block-10)
Suspended
sanction

Suspended Sanction Information
Date Suspended:

Fine

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

Forfeiture

Date Suspended:

Suspension Duration:

Suspended Portion US$:

Suspended Portion Time:

Suspension Conditions:
Date Suspended:
Extra Duty

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Restriction

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Correctional
Custody

Suspended Portion nme:
Suspension Conditions:
Dale Suspended:

Confinement

Suspension Duration:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Reduction in

Gnod.

Date Suspended:
Suspension Conditions:
Dale Suspended:

Probation

Suspension Duration:
Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Special
Assignment

Total
Forfeiture

Suspended Portion Time:
Suspension Conditions:
Date Suspended:
Suspended Portion Time:

Suspension Duration:

Suspension Conditions:
Dale Suspended:

Civil Recovery

Suspension Duralion:

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:
Date Suspended:

Civil Award

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

000031
DA Form 4833 (electronic format). March 2008

Page 5

of

6

ACLU DETAINEE DEATH 2 CID 1517

10. Commander's Remarks

0469·2004-CI DOS6-76341-SH1A

USASCRC Number:

Sanction: F5 2004/11/19

11. Commanding Officer
Was a DNA sample collected from the offender?

Name and Grade:

DYes

ONo

,

Signature:

lS!gnature Date: 11/1912004

AKO e-Mail Address:

DA Form 4833 (electronic format), March 2008

000032
Page 6 of

6

ACLU DETAINEE DEATH 2 CID 1518

COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form, see AR 190-45; the proponent agency is the Provost Marshal General

PRIVACY ACT STATEMENT
AUTHORITY:
PRINCIPAL:
ROUTINE USES:
DISCLOSURE:

Title 10 USC Section 301; Title 5 USC Section 2951: E.G. 9397 dated November 22, 1943
To provide commanders an<llaw er'lforcement officials with means by whiCh (nformation may be accurately k:lentified.
Your Social SectJrity Nllmber is used as an addiliona!la~ernate means of identification to facilitate filing and retrieval,
Disclosure of your Social Security Number is voluntary.

1. Control Information
Thru:

USACRC Number:

0489-2004-CI D056-76341·5H1 A

MP Report Number: NfA
To:

Sub-Installation:

COO2100DC

Referred
By:

Referral Date:

11/1912004

Suspense O.ate:
r he first Lieutenant \,;olonel in Ihe Cllaln 01 command is responsible and accountable for completing DA Form 4833 with support documentatiOn
(copies of Article 15s, court-martial orders, reprimands, etc) for all USACIDC investigations. The unit and brigacle commander or their eqllivalent will
also receive a copy of the DA Form 4833 for all USACIOC investigations.
Company. troop, and battery level commanders are responsible and accountable for completing
cases investigated by MPI, civilian detectives employed by the Department of the Army, and the
reports are required to meet installation. command, HQDA, 000. and federal statutory reporting
trends, establish command programs in law enforcement and other activities, and to ensure lhal
commanders who must address issues of soldier and family member indiscipline

DA Form 4833 with supporting documentation in all
PMO. Accurate and complete DA 4833 disposllion
requirements. TM data is used to identify crime
resources are made available 10 support

In court-martial cases, a conviction of an offense at court-martial may be for e different, or lesser included offense. List the offense for which the
individual was convicted at court-martial in the remarks section. Provost Marshals must enter the "MP Report Numbe(' (Block.1) for all cases referred
to commanders. "Sub·!nstallation" (Block-1) is used to enler repon n\Jmber from a c!vil(an law enforcemerlt agency police report. Other information Orl
the civilian law enforcement agency (e.g. civilian law enforcement agency address) may be entered in the remarks section.

2.

Offender

I~

(b)(6) (b)(7)(C)

E-4 U.S. Army (SPC)

Grade:

Last Name:
First Name:

(b)(6) (b)(7)(C)

Middle Name:

SSN:

Cadency:

Date of Birth:

3.

Referrallnfonnation

ICommander Decision Date:

No.

I

1111912004

Offense

1 Making a False Statement [5M3A)

Basis

Date

UCMJ
Article 107

11312004

2

Ob5\ruetion of JlIslice [5X5]

UCMJ
Article 134

11312004

3

Assessory After The Fact [5X4)

UCMJ
Article 78

11312004

UCMJ
Article 81

1/3/2004

4 Conspiracy [5X1J

5

DA Form 4833 (electronic format), March 2008

Sexual
Harassment

Action Taken

Yes

0

N00

Yes

0

N00

Yes

0

NO[ZJ

Yes

0

NO[ZJ

Yes

0

NO[ZJ

Yes

0

NO[ZJ

Yes

0

N00

V"O

Yes

0

NOD

Yes

b(6), b(7)(C)

0

No0

Reason

Prosecution DedinedlOlher

Prosecution Declined/Other

Prosecution Declined/Other

Prosecution Declined/Othel

NOD

UUUUj"
Page 1

of

6

ACLU DETAINEE DEATH 2 CID 1519

3. Referral Information (continued)

No.

Offense

Basis

Date

Sexual
Harassment

6

NoD

Yes

0

NoD

Y"D NoD

Yes

0

NoD

Yes

7

8

Action Taken

0

YesO

NoD

NoD

YesD

9

Yes

0

NoD Y"D NoD

10

Yes

0

NoD

Yes

0

Reason

NoD

NOTE: For each offerrse marked NO for action taken, you must supply a reason.
If yOll selected "YES" for any offense, continue to "Action Taken" (Block-4). If you selected "NO" for ALL offenses, go directly to 'Commander's
Remarks" (Block-l0), sign, date, and return the form to the agenl specified in "Referred By" (Block-1).

4. Action Taken

o Non-Judicial (Article 15)

DAdmlnistratlve
Non-Adverse Referrals

DJudiclal
Court Martial or Civilian Criminal Court

(see details below)

Adverse Personnel Actions

Non-Judlclal Punishment Authority (select one):

o Summarized
o Company Grade
o Field Grade
o Principal Assistant
5.

OGCMCA Imposed

o General Officer Imposed

Judicial Punishment Authority (select one):

o Summary Court Martial

D Special Court Martial

o General Court Martial

D Civilian CriminallMagistrate

I

I

NJP/Court-Mar1lal/Civilian Criminal Court Proceeding Outcome

No.

Charged Offense

Plea

Finding Offense

Trial
Finding

1 NO ACTION TAKEN - Making a False Statement [5M3A)

2 NO ACTION TAKEN -- Obstruction of Justice !5X5J

J NO ACTION TAKEN -- Assessory After The Fact [5X4J

4

NO ACTION TAKEN _. Conspiracy [5Xl)

5

PLEA: G=Guilty, C=No Conlest, N=Nol Guilty, D=Pre-Trial Diversion, TRIAL FINDING: DCV=Dismissed (Civil), DCR=DismiSSed (Criminal),
P:Finding for Plaintiff, F=Finding for Respondent, G=Guilty, C-No Contest. N=Not Guilty, S-settlement

000034
OA Form 4833 (electronic format), March 2008

Page 2

of

6

ACLU DETAINEE DEATH 2 CID 1520

5. NJP/Court·Martial/Civillan Criminal Court Proceeding Outcome (continued)

No.

Charged Offense

Plea

Finding Offense

Trial
FInding

•
7
8

•
10

PLEA: G=Guilty, C=No Contesl, N"'Nol Guilty, D=Pre-Trial Diversion, TRIAL FINDING: OCV='Oismissed (Civil), DCR;Dismissed (Criminal),
P"'Flnding lor Plaintiff, F=Finding for Respondent, G=Guiity. C"No Conlesl, N-Nol Guitty, S"SelUemenl

6. Administrative Actions
Non·Adverse
Referred

Agency

Responded
Oilte Imposed

amiJy Advocacy

Type of Action
Counseling/Concem

lDrug/Alcohoi Abuse
Special Referral

lKeprimand

Equal Opportunity

~ensure

!Admonition

egalOffice

Written

0 ..' Local OMPF

0
0
0
0

0
0
0
0

0
0
0
0

Mental Health
Relief Agency
Adverse
Description

Date Imposed
\!Vithholding of Privileges

Adverse Performance Evaluation (OER/NCOERJAcademic Report)
Relief for Cause (OERINCOER)
Mandatory Reassignment
ransfer (such as rehabilitative)
Adverse Record Entry - Flag
Denial of Reenlistment or Continued Service
jVVithhokling of Promotion
Delay of Promotion
Promotion Revocation
Clearance Revocatioo
Control Roster (downgrade of dearance, PRP redassification)
Resignation
Retirement
Retirement at Lower Grade

From:
To:

Transfer to Inactive Reserve

000035
DA Form 4833 (electronic format), March 2008

Page 3 of

6

ACLU DETAINEE DEATH 2 CID 1521

6. Administrative Actions (continued)
Date Imposed

Description
Military Occupational Specialty Reclassification
Debarment

Duration:

ob Termination
ob Suspension

Duration:

leave lNithout Pay
loss of Warrant

Duration:

estitution (to US Government)
Restitution (to third party Non-US Government)
Civil-Civil Action Initiation

Amount;
Amount;

o Days o Months
o Days o Months
o Days o Months

DVears
DVears

o Days o Months

DVears

DVears

~untary Disdosure

Other (return to Slates, etc.)
Contract Suspension

Duration:

K:ontract Termination
Cost Adjustment

Amount:

Bid Rejection
Amount:

Recoupment
Denial of Continuation
Other Contract Action
7. Details of Administrative Separation
Date Imposed
Regulation
Chapter
Characterization
Effective Dale

Proceed to Commander's Remarks (Block.10) if you chose Administrative Action
8. Non-Judlcial/Judlclal Sanctions
Sanction

Date AdjUdged
Fine

Amount:

Forfeiture

Amount:

Extra Duty

Days:

Restriction
Correctional Custody

Days:
Days:

Confinement

Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge
Reduction in Grade

Effective Date:
Front
To:

Probation

Duration:

Duration:
Special Assignment
otal Forfeiture (all payfanowance)Duration :

Duration:

o Days o Months

o Days o Months

DVears

o Days
o Days

DVears
DVears

DDays

o Months
o Months
o Monlhs

o life

DVears

oure

Death
Civil Recovery

icrv~ Award

Amount:
Amount:

,

DA Form 4833 (electronic ronnat). March 2008

oooo.::G
Page 4

of

6

ACLU DETAINEE DEATH 2 CID 1522

9. Suspended Sanctions
Were Any Sanctions Suspended?

DYes
0No
If no sanctions were suspended, proceed 10 ·Commander's Remarks" (Block.1 0)
Suspended
Sanction

Suspended Sanction Infonnation
Date Suspended:

Fine

Suspension Duration:

Suspended Portion USS:
Suspension Conditions:

Forfeiture

Date Suspended:

Suspension Duration:

Suspended Portion US$:

Suspended Portion Time:

Suspension Conditions:
Dale Suspended:

Extra Duty

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Restriction

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Correctional
Custody

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Confinement

Suspension Duration:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Reduction in
Grade

Date Suspended:
Suspension Conditions:
Date Suspended:

Probation

Suspension Duration:
Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Special
Assignment

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Tolal
Forfeiture

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Civil Recovery

Suspension Duration:

SuspenslOfl Duration:

Suspended Portion US$:
Suspension Collditions:
Date Suspended:

Civil Award

SuspensiOfl Duration:

Suspended Portion USS:
Suspension Conditions:

000037
DA Fonn 4833 (electronic fonnat). March 2008

Page 5

of

6

ACLU DETAINEE DEATH 2 CID 1523

10. Commander's Remarks

0489-2004-CID056- 76341-5H lA

USASCRC Number:

Sanction:

F52004/11/19

11. Commanding Officer
Was a DNA sample collected from the offender?
Name and Grade:

DYes

DNo

•

Signature:

lSignature Date: 1111912004

AKO e-Mail Addre$$:

OA Fonn 4833 (electronic format), March 2008

Page 6

of

6

000038
ACLU DETAINEE DEATH 2 CID 1524

COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form. see AR 190-45; the proponent agency is the Provost Marshal General

PRIVACy ACT STATEMENT
AUTHORITY:

PRINCIPAl:

ROUTINE USES:
DISCLOSURE:

Tille 10 USC Section 301: Title 5 USC Section 2951: E.O. 9397 dated November 22, 1943
To provide commanders and law enforcement offidals with means by which information may be 8ceuralely identified,
Your Social Security Number is used n an additionatJatlernale means of identification to facilitate filing and retrieval.
Disclo$ure olyour Socia! Security Number is vOIl.lntary.

1. Control Information
Thl1J:

USACRC Number:

0489-2004-CI 0056-76341·5H 1A

MP Report Number: N/A

0'
Referred

By:

Sub-fnstallatlon:

CQ02100DC

Referral Date:

11119/2004

Suspense Date:

~irst Lieul.enan~

l~

acco~ntabl.e

For~

The
colonel in
chain of command .s responsible and
lo.r completing.DA
4833wrtll support documentatIon
(copIes of ArtIcle 15s, coun-martlal orders, reprimands, etc) for alt USACIDC Investigations. The uOil and bngade commander or their equivalent will
also r~ceive a copy of Ihe DA Form 4833 for atl USACIDC investigations.
Company. troop, and battery level commanders are responsible and accountable for completing DA Form 4833 willl supporting documentation in all
cases Invesligated by MPI. civilian detectives employed by the Department of Ihe Army, and the PMO. Accurate lind complete DA 4833 disposition
reports are required to m~t instaliatiOl1, command, HQDA. DOD. and federal statutory reporting requirements. The data is used to identify crime
trends, establish command programs in law enforcement and other activilies, arid to ensure that resources are made available to support
commanders who must address issues of soldier and family member indisciplirle.
In court-martial cases. a convictiM of an offense at court-martial may be for a different, or lesser included offense. Ust the offense fOI which the
lndividual was convicted at court-martial in the remarks section. Provost Marshals must enter the "MP Report Number" (Block-1) for all casel; referred
to commanders. ·Sub-Installation" (Block-1) is used to enter report number from a civilian law enforcement agency police report. Other inforr11ation on
the civilian law enforcement agency (e.g. civilian law enforcement agency address) may be entered in the remarks section,

2. Offender Identification
(b)(6) (b)(7)(C)
Last Name:

E-3 U.S. Army (PFC)

Grade:

First Name:

(b)(6) (b)(7)(C)

Middle Name:

SSN:

Cadency:

Oate of Birth:

3.

Referral Information

ICommander

No.

Decision

Oate:

I

1111912004
Basis

Date

1 Premedijated Murder [5H1A)

UCMJ
Article 116

i1J/2004

2 Aggravilled Assalllt {SC1D]

UCMJ
Article 128

11312004

UCMJ
Article 107

1/312004

UCMJ
Article 134

11312004

UCMJ
Article 8t

113/2004

3

Offense

Making a Filise Stalemerl! (5M3A]

4 Obslruction of Justice /5X5}

5

Conspiracy [5X1]

OA Form

4833

(electronic format), March

2008

Sexual
Harassment
Yes

Yes

0
0

YesD

Yes

0

YesD

N00

No[Zl

Action Taken

Y~D

Yes

0

No[t]

Prosecution Declined/Other

fosecution DeclinedfOther
N00

No[Z)

YesD

NO{ZJ

Yes

0

""0

No0

Yes

0

N00

b(6), b(7)(C)

Reason

No[Z)

rcsecl/!ion DeclinedlOlher

PrtlsecutiOrl Declined/Other

Prosecution Declined/other

VUUU",'j
Page

1

of

6

ACLU DETAINEE DEATH 2 CID 1525

3. Referrallnfonnation (continued)

No.

Offense

Basis

Date

Sexual
Harassment

6
7

8

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

0

NoD

Yes

10

Reason

NoD Y"D NoD

YesO

9

Action Taken

0

YesO

NoD

Yes

0

NoD

NoD

Yes

0

NoD

NOTE: For each offense marked NO for action taken, you must supply a reason.
If you selected ~YES" for any oHense, conlinue to ~Acfion Taken" (Block-4). If you selectea "NO" for ALL offenses. go directly /0 "Commander's
Remarks· (Blocl<-10), sign, date, and retum the form to the agent specified in "Referred By· (BIock.-l).

4.

Action Taken

o

OAdministratlve
Non·Adverse Referrals

NQn-Judie-lal (Article 15)

OJudiclal

(see details below)

Court Martial or Civilian Criminal Court

Adverse Personnel Actions

Non-Judlcial Punishment Authority (select one):

o
o
o
o
5.

Summarized
Company Grade

o
o

GCMCA Imposed
General Officer Imposed

Field Grade
Principal Assistant

NJP/Court·MartiallClvilian Criminal

No.

Judicial Punishment Authority (select one):

o
o
o

Summary Court Martial

o

General COlJrt Martial

Special Court Martial
Civilian CrimlnallMagislrate

I

I

Court Proceeding Outcome

Charged Offense

Plea

Finding Offense

Trial
Finding

1 NO ACTION TAKEN .• Premedrtated Murder [5H1AI

2 NO ACTION TAKEN .. Aggravated AssaUlt [5C lDI

3 NO ACTION TAKEN·- Making a False Statement [5MJAI

•

NO ACTION TAKEN.· Obstruction of Justice [5X51

5 NO ACTION TAKEN •• Conspiracy [5Xl/

PLEA.. G:GuiJly, C=No Conlesl, N"Nol GUill}', D"Pre·Trial Diversion, TRIAL fINDING: OCV"Di~missed (CiVil), DCR"DismiSsed (Criminal),
P"'Flnding for Plaintiff, F=Finding for Respondenl, G"'Guifty, C"No Contest, N"'Not Guilty, S"'Settfement

000040
OA Form 4833 (electronic (annat), March 2008

Page

2

of

6

ACLU DETAINEE DEATH 2 CID 1526

5. NJP/Court~Martial/CivilianCriminal Court Proceeding Outcome (continued)

No.

Charged Offense

Plea

Finding Offense

Trial
Finding

6

7

8

9

10

PLEA: G"'Guilt~, C:=No Contest. N"'Not Guilty, D"'Pre-Trial Diversion, TRIAL FINDING: DCV=Dismissed {Civil), DCR=Dismissed (Criminal),
P;Finding for Plaintiff, P=Finding for Respondent, G=Guilty, C=No Contest, N=Not Guilty, S=Settlement

6. Administrative Actions
Non-Adverse

Agency

Referred

Responded

Written
Date Imposed

Family Advocacy

Type of Action

0",' Local OMPF

Special Referral

Counseling/Concern
Reprimand

Equal Opportunity

Censure

Legal Office

!Admonition

Drug/Alcohol Abuse

0
0
0
0

0
0
0
0

0
0
0
0

Mental Health
Relief Agency
Adverse
Description

Date Imposed

Withholding of Privileges
Adverse Performance Evaluation (OERlNCOER/Academic Report)
Relief for Cause (OER/NCOER)

Mandatory Reassignmenl
Transfer (such as rehabilitative)
fAdverse Record Entry· Flag
Denial of Reenlistment or Continued Service
Withholding of Promotion
Delay of Promotion
Promotion Revocation
Clearance Revocation
Control Roster (downgrade of dearance, PRP reclassification)
Resignation
Retirement
Retirement at lower Grade

From:
To:

Transfer 10 Inactive Reserve

000041
OA Form 4833 (electronic format), March 2008

Page 3

of

6

ACLU DETAINEE DEATH 2 CID 1527

6. Administrative Actions (continued)
Date Imposed

Description
Military Occupational SpeCialty Reclassification
Debarment

Duration:

DDays

DMonths

Job Suspension

Duration:

Leave Without Pay

Duration:

DDays
DDays

D Months
D Months

o Years
o Years
o Years

DDays

DMonths

DYears

Job Termination

loss of Warrant
Voluntary Disclosure
Restitution (to US Government)
Restitution (to third party Non·US Govemment)
Civil-Civil Action Initiation

Amount:
Amount:

Other (return to states, etc.)
Contract Suspension

Duration:

Contrad Termination
Cost Adjustment

Amount;

Bid Rejection
Amounl:

Recoupment
Denial of Continuation
Other Contract Action

7. Details of Admlnlstrative Separation
Date Imposed
RegUlation
Chapter

•

Characterization
Effective Date
Proceed to Commander's Remarks (BIOCk-1 0) if you chose Administrative Action

8. Non..JudiciallJudicial Sanctions
Sanction

Cate AdjUdged
Fine
Forfeiture

Amount:

Extra Duty

Days:

Restriction
Correctional Custody

Days:

Confinement

Duration:

Amount:

Days:
Duration:

Bad Conduct Discharge

Effective Date:

Dishonorable Discharge
Reduction in Grade

Effective Date:

DDays

DMonths

DDays
DDays

OMonlhs
Months

DYears

DUfa

From:
To:

Probation

DDays DMonths

Duration:

Duration:
Special Assignment
Totat Forfeiture (all pay/aUowance)Ouration :

DOays

o

o Months

o Years
DYears
DYears

DUfe

Death
Civil Recovery

Amount:

Civil Award

Amount:

000042
OA Form 4833 (electronic fonnat), March 2008

Page 4

of

6

ACLU DETAINEE DEATH 2 CID 1528

9. Suspended Sanctions
Were Any Sanctions Suspended?

If no sanctions were
Suspended
Sanction

Suspended Sanction Information
Date Suspended:

Fine

0No
DYes
suspended, proceed to "Commander's Remarks" (Block-1 0)

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

Forieiture

Date Suspended:

Suspension Duration:

Suspended Portion US$:

Suspended Portion Time:

Suspension Conditions:
Date Suspended:
Extra Duty

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Restriction

Suspended Portion Time:
Suspension Conditions:

Date Suspended:
Correctional
Custody

Confinement

Suspension Duration:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:
Date Suspended:

Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Reduction in
Grade

Dale Suspended:
Suspension Conditions:
Date Suspended:

Probation

Suspension Duration:
Suspension Duration:

Suspended Portion Time:
Suspension Conditions:

Dale Suspended:
Special
Assignment

Total
Forieiture

Suspended Portion Time:
Suspension Conditions:
Date Suspended:
Suspended Portion Time:

Suspension Duration:

Suspension Conditions:
Date Suspended:

Civil Recovery

Suspension Durelion:

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:
Date Suspended:

Civil Award

Suspension Duration:

Suspended Portion US$:
Suspension Conditions:

000043
DA Form 4833 (electronic format), March 2008

Page 5

of

6

ACLU DETAINEE DEATH 2 CID 1529

10. Commander's Remarks

0489-Z004-CJD056-76341 ~5H 1A

USASCRC Number:

Sanction:

F52004111119

11. Commanding Officer
Was a DNA sample collected from the offender?
Name and Grade:

DYes

ONo

,

Signature:

l$ignature Date; 11 f1912004

IAKO e-Mail Address:

OA Fonn 4833 (electronic fonnat), March 2008

ACLU DETAINEE DEATH 2 CID 1530