CASE SUMMARY                        ___________________
                                                                                                                                         ___________________
                                                                                                                                         ___________________

NAME: _____________________________________________

RANK:______________________________________________

NUMBER:___________________________________________

BRANCH OF SERVICE:_______________________ CAREER FIELD:___________________________

WHERE STATIONED:___________________________________________________________________

AGE:_________  DATE & PLACE OF DEATH:_______________________________________________

CAUSE OF DEATH:______________________________________________________________________

MANNER OF DEATH:___________________________________________________________________

WHERE LIVING AT TIME OF DEATH:____________________________________________________

NAMES OF PERSON(S) LIVING WITH:____________________________________________________

HOW LONG IN SERVICE:_______________________________________________________________

SPOUSE:________________________ CHILDREN:___________________________________________

NAME OF PARENT(S) OR RELATIVE(S) AUTHORIZING INQUIRY:__________________________

___________________________________________________________RELATIONSHIP:____________

ADDRESS:_____________________________________________________________________________

E-MAIL:______________________________ TELEPHONE:____________________________________

OCCUPATION:_________________________________________________________________________

ADDRESSES, E-MAIL & PHONE OF OTHER RELATIVES SUPPORTING INQUIRY:____________

_______________________________________________________________________________________

_______________________________________________________________________________________

YOUR OCCUPATION:___________________________________________________________________

AGENCIES INVESTIGATING DEATH (CIVILIAN AND / OR MILITARY)
_______________________________________________________________________________________

NAME OF LEAD INVESTIGATOR/OR PERSON SIGNING OFF ON THE INVESTIGATION:

ADDRESS AND PHONE NUMBER OF THAT OR THOSE AGENCIES:
_______________________________________________________________________________________

_______________________________________________________________________________________

LIST THE INVESTIGATIVE REPORTS THAT YOU HAVE BEEN PROVIDED:__________________

DO YOU HAVE:  CRIME SCENE PHOTOS:_________________________________________________
                               FORENSIC REPORT________________SIGNED BY WHO:____________________
_______________________________________________________________________________________
                              AUTOPSY REPORT:________CONDUCTED AND SIGNED BY WHO:___________
                              PATHOLOGY REPORT:__________SIGNED BY WHO:________________________
_______________________________________________________________________________________

                               WAS ANALYSIS OF CLOTHING PERFORMED:_____________________________

                               WERE FINGERPRINTS TAKEN AT CRIME SCENE OR OF ANYONE RELATING
TO THE CASE __________________________________________________________________________

________________________________________________________________________________________

                                FUNERAL HOME:_______________________________________________________

DID YOU HAVE INDEPENDENT AUTOPSY:__________WHEN:________________________________
                                BY WHO:____________________________

HAVE YOU HAD INDEPENDANT EVALUATION PERFORMED ON ANY ASPECT OF CASE:______
                               WHEN: ______________

DID YOU HIRE A PRIVATE INVESTIGATOR:_____________
   NAME AND ADDRESS:_________________________________________________________________
   PHONE/E-MAIL:_______________________________________________________________________

HAD THE DECEASED WRITTEN OR TOLD YOU/OR ANYONE ABOUT ANY UNUSUAL ACTIVITY,
PROBLEM OR CONCERN IN THE MONTHS PRIOR TO HIS DEATH:__________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

HAD THE DECEASED MENTIONED THE NAMES, OR NICKNAMES OF ANY PARTICULAR INDIVIDUALS THAT HE RELATED TO THESE PROBLEMS, INCLUDING OFFICERS, OTHER SER-
VICE MEMBERS, ETC.:____________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

HAD THE DECEASED MENTIONED:  GANGS, FRATERNITIES, HAZING, DRUGS, GUNS AND IF SO,
IN WHAT CONNECTION AND WHERE:______________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

WERE ALL PERSONAL BELONGINGS RETURNED:___________________________________________

__________________________________________________________________________________________

WAS THE INVENTORY VIDEOTAPED OR ON PAPER:_________________________________________

HAVE YOU BEEN TAPE-RECORDING CONVERSATIONS WITH INDIVIDUALS INVOLVED WITH
THE INVESTIGATION:_____________________________________________________________________

NAME EACH PERSON AND AGENCY OR MEMBER OF CONGRESS FROM WHOM YOU HAVE RE-
QUESTED ASSISTANCE AND THE RESULTS:_________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

ARE YOU RECEIVING OR DID YOU RECEIVE TIMELY RESPONSE AND REPORTS IN RESPONSE TO YOUR REQUESTS FOR DOCUMENTATION FROM THE DEPARTMENT OF DEFENSE:____________

___________________________________________________________________________________________

                    WHAT INFORMATION HAS BEEN DENIED AND BY WHO:___________________________

___________________________________________________________________________________________

DESCRIBE ANY INFORMATION, LETTERS OR CALL FROM FRIENDS OR OTHER INDIVIDUALS
CONCERNING THE DEATH:_________________________________________________________________

___________________________________________________________________________________________

HAVE YOU MADE PERSONAL CONTACT WITH A SERVICE FRIEND:____________________________

DID THE DECEASED HAVE ANY SPECIFIC PROBLEMS (MONEY, HEALTH, MARRIAGE, ETC.):____

____________________________________________________________________________________________

SPECIFICALLY DESCRIBE WHAT HAPPENED TO THE DECEASED:______________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

DID THE DEPARTMENT OF DEFENSE PERFORM A PSYCHOLOGICAL AUTOPSY AND WHO SIGNED
PERFORMED IT (NAME):____________________________________________________________________

WHAT, IF ANYTHING, IN THE PSYCHOLOGICAL AUTOPSY CAN BE PROVED FALSE:_____________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

IN THE PSYCHOLOGICAL AUTOPSY WERE THERE SPECIFIC AND UNFOUNDED ALLEGATIONS
MADE ABOUT THE DECEASED:______________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

DID YOU REQUEST A REINVESTIGATION BY THE DOD INSPECTOR GENERAL:__________________
WHEN:_______________HAVE YOU RECEIVED THAT RESULT:___________________________________

                                                AUTHORIZATIONS

I (WE) ARE WILLING TO SPEAK TO THE PRESS/MEDIA:________________________________________

                    SIGNED:______________________________________

                                    ______________________________________

TELEPHONE:_________________WORK:______________________________

ALL INFORMATION CONCERNING THIS CASE CAN BE GIVEN TO THE PRESS/MEDIA:__________

                    SIGNED:_________________________________________________________________________

MY MEMBERS OF CONGRESS MAY BE CONTACTED CONCERNING MY CASE:_________________
                    SIGNED:_________________________________________________________________________

I (WE) ARE WILLING TO HAVE THE CASE FILE AND ALL RELATED INFORMATION SUBMITTED TO THE APPROPRIATE CONGRESSIONAL COMMITTEE (HOUSE OR SENATE) OR INDIVIDUAL MEMBERS OF CONGRESS FOR THEIR REVIEW:____________________________
                    SIGNED:_______________________________________________________

I (WE) WANT TO BE CONTACTED BY MEMBERS OF THE SUPPORT GROUP RELATED TO THE ISSUE
OF ALLEGED SELF-INFLICTED DEATHS IN THE MILITARY:

                  SIGNED:__________________________________________________________________________

FULL INFORMATION CAN BE SHARED WITH MEMBERS OF THAT GROUP:_____________________
                  SIGNED:________________________________________

I (WE) COULD, I (WE) WOULD TRAVEL TO WASHINGTON, D.C. FOR MEETINGS, HEARINGS, AND
OTHER EFFORTS:_____________________________

I (WE) HAVE VERY LIMITED FINANCIAL MEANS TO TRAVEL:__________________________________

I AM ABLE TO HELP THE EFFORT BY DOING THE FOLLOWING: (E-MAIL, LETTERS/POSTAGE,
COPYING, WRITING, ETC.)___________________________________________________________________