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

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