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Claims
Form
To: United States Army Foreign Claims Commission.
From: ~ame:a-~ Sex:
-
Address:
&.Zc'z
-
/Zc&-d/
----
-
I
am a citizen and national of:
Name of Unit or US Personnel involved in incident:
Owner of property that was damaged:
My
claim arose on:
&
/p
&€I<
m-
02FO
Month Day Year Time
I
claim as damages: (Indicate amount in U.S. dollars and local currency)
$
"
al,@J
local
Subscribed before me this day of
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200A