MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C4FA84.E00B4AC0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C4FA84.E00B4AC0 Content-Location: file:///C:/299B6073/e1s6sub3.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Housing and Land Rights Violation Case Documentation Form

 = ;

Housing and Land Rights Violation Case Documentation F= orm

 

&nbs= p;

Housing  Rights

 =

 =

I.        &= nbsp; The violation

Date(s) of violation: ---/-------/---- (through ---/-------/----)

 

Time(s) of violation: ---/-------/---- (through ---/-------/----)

 

Date you began this = record: --/--/---- Date you completed this record: --/--/----

 

Type of area: urban = q  s= uburban q  r= ural q  camp q  planned and serviced area q  i= nformal settlement q  f= arm house q  n= omadic housing q  f= orest dwelling q

 

What is the type of violation? forced eviction q  house demolition  q  denial of inheritance  q

confiscation  q  damage to home and/or property  q  environmental degradation  q other <= /span>q

If other, define the violation: ­­­­­­­­­­­­­= ;­­­­­-------------------------------------------------= -----

 

 =

II.  =        Identify affected community / persons

II.A      If affected persons form a community:

What is th= e name by which the community is commonly known? --------------------------

 = ;

Does the c= ommunity have another name for themselves? What is it?  ----------------------<= /span>

 = ;

Give the p= recise location of the affected group or community:

 = ;

Address/location:        &= nbsp;           &nbs= p;            &= nbsp;        --------------------= ---  --------------------- <= /span>

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Type of affected are= a:  city q  town  q  village  q  slum q  camp q  caravan  q  slum q

informal settlement = q  planned and serviced area <= span style=3D'font-size:18.0pt;font-family:Wingdings;mso-ascii-font-family:Arial; mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type:symbol; mso-symbol-font-family:Wingdings'>q  

 

What is the community’s size= and composition? (Approximate, if you must, but try to be as accurate as possib= le.)

 

What is the community’s total population?

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What number and/or proportion of the individuals in the community affected?

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How many families in the community?

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&nb= sp;

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What number and/or proportion of families affected?

&nb= sp;

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In the community, how many affected people are male?

&nb= sp;

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In the community, how many affected people are female?

&nb= sp;

&nb= sp;

&nb= sp;

&nb= sp;

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 =

Also identify the nu= mbers and/or proportions of children, minorities, persons with special needs (med= ical conditions, disability, elderly) and those subject to historic discriminati= on:

--------------------= ----------------------------------------------------------

--------------------= ----------------------------------------------------------

--------------------= ----------------------------------------------------------

--------------------= ----------------------------------------------------------

 =

 =

II.B      If affected persons are individuals:

Full name of owner/t= enure holder: --------------------  ------------ --------------

 

Nationality: ----------------  (and citizen= ship, if different: -------------------)

 

I.D. number: -------------------- Type of document: -----------

 

Complete address of affected housing unit:

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Type of affected are= a:  city q  town  q  village  q  slum q  camp q  caravan  q  slum q

informal settlement = q  planned and serviced area <= span style=3D'font-size:18.0pt;font-family:Wingdings;mso-ascii-font-family:Arial; mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type:symbol; mso-symbol-font-family:Wingdings'>q  

 

Complete current address (if different):  =    

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   ----------- ------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

            =             &nb= sp;            =            Other:<= span style=3D'mso-tab-count:2'>        &= nbsp;     -------- ------- ------

 

Sex/gender:   q Female    q Male   q Other

 

Civil status:    q single  <= /span>q  p= artnered    q married &n= bsp;  q separated  q divorced = q widowed

 

Birthdate:       --/--= ---/----

 

Full name of spouse = (if any):  ­­­­&sh= y;­­­­­­­­­­­­­--------= -------- ----------- --------------

 

(Additional names, if more than one spouse: ­­­­­­­­       -----= ------- ---------- ------------

­­­­­­­­        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;             = ----------- ---------- ------------

­­­­= ­­­­        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;             = ------------ ---------- ------------

 

Names and ages of children:   &nbs= p;            &= nbsp;           &nbs= p;      ------------ ---------- (age)--------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;         &= nbsp;   ------------ ---------- (age)--------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;             = ------------ ---------- (age)--------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;             = ------------ ---------- (age)--------

[Copy & paste= this section to add lines as needed.]

 =

Refugee status:  q registe= red refugee    q not registered refugee

 

Occupation:   -------------------        &= nbsp;   Workplace:    -----------------------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; Address:        -----------------------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;            -----------------------

            =             &nb= sp;            =             &nb= sp;            =           Work Tel:        ------ ------ ------

 

Residents:      q nuclear family&= nbsp;     q extended family=     q  multiple families=

 

List all residents:     = ;  ------------ -------- ---------- (age)----

        &= nbsp;           &nbs= p;            &= nbsp;  ------------ -------- ---------- (age)----

        &= nbsp;           &nbs= p;            &= nbsp;  ------------ -------- ---------- (age)----

        &= nbsp;           &nbs= p;            &= nbsp;  ------------ -------- ---------- (age)----

        &= nbsp;           &nbs= p;            &= nbsp;  ------------ -------- ---------- (age)----

        &= nbsp;           &nbs= p;            &= nbsp;  ------------ -------- ---------- (age)----

[Copy & paste= this section to add lines as needed.]

 

Also identify the nu= mbers and/or proportions of children, minorities, persons with special needs (med= ical conditions, disability, elderly) and those subject to historic discriminati= on:

--------------------= ----------------------------------------------------------

--------------------= ----------------------------------------------------------

--------------------= ----------------------------------------------------------

--------------------= ----------------------------------------------------------

 

Is victim/tenure hol= der also the household provider?  q Yes  q No   If Yes, s/he provides for  ---  adults  --- children.  If no, name provider: --------- --= ------ -----  Is provider also reside= nt? q Yes  q No

 

If no, give contacts:  

Street address:        &= nbsp;           &nbs= p;            &= nbsp;           --= ---------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication number= s:    Telephone:     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

            =             &nb= sp;            =            Other:<= span style=3D'mso-tab-count:2'>        &= nbsp;     -------- ------- ------

 

If victim is not owner, identify owner/landlord:       

Full name:       &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;         --------- --------- ---------- 

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

            =             &nb= sp;            =            Other:<= span style=3D'mso-tab-count:2'>        &= nbsp;     -------- ------- ------

III.        Identifying the means of violation

Cause of loss/damage/destruction:  demo= lition q  explosives q  occupation q  vandalism  q

pollution q  toxic waste q  natural disaster q  other  q (describe: --------------------)

 

Means of damage/destruction:  bulldozer= q  gunfire/artillery q  airborne missile q  r= ocket q gas q  tank q  other   q  (describe: -------------------­= ;­­­­­­­­­­­­­­­= ;­--------------------------)

 

Identify type and origin of destructive means:  Brand/company of manufacture:  --------------

Model: -------------=   Country of origin: -------------  Serial number: -----------------

 

Direction of violati= on (from):  q  m= ilitary base  q military position or checkpoint&nbs= p; q aircraft =

q tank  q military personnel/infantry/militia   q settlers  q other ­­---------------------

 

 

IV.       Ident= ifying duty holder(s):

Status of principal perpetrator:  q  p= rivate actor  q public official/officer  q corpora= tion

 

Identity of principal perpetrator, or immediately responsible public official/officer:       =

 

Full name: --------- --------- ----------  Title: ­­­­----------  Rank: ----------  Serial/identification no. -------------------  Police un= it:  ­­­----------

Armed service branch= : ­­­­­­­­­­­­­­&sh= y;­­­­­-------------------  Unit: ­­­­­---= -------------

[Copy & paste= this section to add lines as needed.]

 

 

Commander/superior officer:

Full name: --------- --------- ----------  Title: ­­­­----------  Rank: ----------  Serial/identification no. -------------------  Police un= it:  ­­­----------

Armed service branch= : ­­­­­­­­­­­­­­&sh= y;­­­­­-------------------  Unit: ­­­­­---= -------------

 

 

Identity of prin= cipal perpetrator, or immediately responsible private party:       

q corporate official(s)  q settler= (s)  q other: ------------------

 

Name: ----------- ---------- ----------  Title: ­­­­----------  Rank: ----------  Identification no. -------------------           =    Party represented: ----= -­­­----------

Relationship to vict= im(s), if any: ­­­­­­­­­­­­­&s= hy;­­­­­­------------------- 

[Copy & paste= this section to add lines for more identifiable parties as needed.]

 

 

Who ordered the violation (if different from principal perpetrator)?=

Full name: --------------------  --------= ---- --------------

 

Nationality (and citizenship, if different): -------------------

 

I.D. number: -------------------- Type of document: -----------

 

Complete address:

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Other:        &= nbsp;     ­­­­-------- ------- ------

 

What reasons, if any= , have those responsible (duty holders, violators) given for the violation?

 

 

 

Who gave those reasons?

Full name: --------------------  ------------ --------------  Title: ­­­-----------<= o:p>

Position: ------------------------   Official position: q  Civilian position: q

Employer:

Nationality ------------------- (and citizenshi= p, if different): -------------------

I.D. number: -------------------- Type of document: -----------

 

Contact information:

Organization:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;   ----------------------------

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

 

 

IV.A     Identify duty-hol= ding manufacturer of the destructive means (if appropriate):

 

Company:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;        -----------------------= -----

CEO:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   ---------- ------- ----------

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

            =             &nb= sp;            =            Mobile:        &= nbsp;  -------- ------- ------

 

 

IV.B    Identify duty-holding supplier/importer of the destructive means (if appropriate):

 

Company:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;        -----------------------= -----

CEO:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   ---------- ------- ----------

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

            =             &nb= sp;            =            Mobile:        &= nbsp;  -------- ------- ------

 

 

IV.C    Identify duty-holding l= ocal distributor of the destructive means (if appropriate):

 

Company:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;        -----------------------= -----

CEO:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   ---------- ------- ----------

Street address:      = ;            &n= bsp;          &= nbsp;           &nbs= p;   -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;           &= nbsp;           &nbs= p;   Fax:        &= nbsp;        -------- ------- ------

            =             &nb= sp;            =            Mobile:        &= nbsp;  -------- ------- ------

 

 

V.  &nbs= p;     Documenting consequences:

Which type of tenure victim(s) hold:    <= /span>q own  q rent  q lease q squat

 

Ground area of structure:    &= nbsp;           &nbs= p;            ----- square meters

Floor space of resid= ential unit:      &n= bsp;            = ; ----- square meters 

 

Type of property aff= ected:    q villa  q single family home q duplex  q multistory structure

q  a= partment q commercial property  q kiosk <= /span>q wall/fence q plot of= land q infrastructure q other  If other, describe: ------------------------------------------------------

 

If multiplex or mult= istory structure, how many storeys? -----  How many units? -----

 

How many rooms in st= ructure? ­­­----  How many = rooms affected? ­­­­----

 

Does the affected ho= using unit have:  q kitchen? = q bathroom?  q living room?&n= bsp; q garage?

q bedroom? How many? ----

 

Degree of affect: q complete unit(s) no. of units ----  q partial= no. of units ----

 

 

Housing Rights Violation “Loss Matrix”

T= ype and description of cost/loss

Q= uantification method

V= alues/

l= osses

L= ong-term values/ losses

T= otals

Victims’ Material Losses

Structure<= /o:p>

 

 <= /span>

 <= /span>

 <= /span>

Walls

Number and mass (i= n square meters) @ replacement value

 <= /span>

 <= /span>

 <= /span>

Doorways (frames a= nd doors)

Number (wooden) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Number (wooden &am= p; glass) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Number (metal) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Number (metal &= ; glass) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Number (other) @ replacement value

 <= /span>

 <= /span>

 <= /span>

Window frames=

Number (wooden fra= me) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 

Number (metal fram= e) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Number (other) @ replacement value

 <= /span>

 <= /span>

 <= /span>

Windowpanes

Size and grade @ r= eplacement value

 <= /span>

 <= /span>

 <= /span>

Roofing=

Surface area & material (wooden, shingled) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Surface area & material (concrete) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Surface area & material (metal) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Surface area & material (thatch) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Surface area & material (other) @ replacement value

 <= /span>

 <= /span>

 <= /span>

Infrastructure installations

Heating & cool= ing systems

Gas heaters @ repl= acement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Gas furnace @ repl= acement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Oil heaters @ repl= acement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Oil furnace @ repl= acement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Electric heaters @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Electric furnace @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Solar heating unit= s @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

AC units @ replace= ment value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Central AC @ repla= cement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Gas water heaters @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Oil water heaters @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Electric water hea= ters @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Solar water heater= s @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Other(s) @ replace= ment value

 <= /span>

 <= /span>

 <= /span>

Plumbing

Replacement value = pipes, drainage, water-delivery system, sanitation & cost of labor to replac= e

 <= /span>

 <= /span>

 <= /span>

Electrical install= ations

Replacement value = of wiring, fixtures & cost of labor to replace

 <= /span>

 <= /span>

 <= /span>

Other utilities

Replacement values= of gas and oil pipelines, fixtures and related installations & cost of labor= to replace

 <= /span>

 <= /span>

 <= /span>

Contents

Furniture

Number of beds with mattresses by type @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Number of cabinets= by type @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Vanity & dress= er (x number) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Shelving

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Sofas (x number &a= mp; type) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Chairs (x number &= amp; type) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Tables (x number &= amp; type) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Carpets (by number= , type & size) @ replacement value

 <= /span>

 <= /span>

 <= /span>

Decor

Inventory by numbe= r and type @ replacement value

 <= /span>

 <= /span>

 <= /span>

Appliances

Television(s) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Computer(s) @ repl= acement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Refrigerator(s) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Oven(s) & stov= e(s) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Clothes washer @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Clothes dryer @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Sound equipment (recorders, music systems) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Other @ replacemen= t value

 <= /span>

 <= /span>

 <= /span>

Kitchen items=

Kitchen appliances= @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Inventory of dishe= s, cutlery, cooking utensils, pots & pans @ replacement value=

 <= /span>

 <= /span>

 <= /span>

Clothing

Inventory by item = and value @ replacement value

 <= /span>

 <= /span>

 <= /span>

Personal items

Replacement values= of books, recordings, memorabilia, collections and all personal items lost

 <= /span>

 <= /span>

 <= /span>

Plot

Current market val= ues (before violation)

 <= /span>

 <= /span>

 <= /span>

Plants & veget= ation

Houseplants @ repl= acement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Shrubbery @ replac= ement value

 <= /span>

 <= /span>

 <= /span>

Trees

Fruit bearing=

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Ornamental @ repla= cement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Demarcating land @ replacement value

 <= /span>

 <= /span>

 <= /span>

Crops

Number of plants @= replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Harvest value=

 <= /span>

 <= /span>

 <= /span>

Animals & livestock<= /p>

 

Household pets @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Cattle (market val= ue at maturity)

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Sheep (market valu= e at maturity)

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Goats (market valu= e at maturity)

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Poultry (market va= lue at maturity)

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Other (market valu= e at maturity)

 <= /span>

 <= /span>

 <= /span>

Vehicles and equipment<= /p>

Vehicles

Automobile(s) @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Utility vehicle(s)= @ replacement value

 <= /span>

 <= /span>

 <= /span>

Equipment

Business & off= ice machines

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Manufacturing equi= pment & machines

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Cultivation and ha= rvest equipment @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Farm equipment @ replacement value

 <= /span>

 <= /span>

 <= /span>

Tools

Farming implements= @ replacement value

 <= /span>

 <= /span>

 <= /span>

 <= /span>

Other @ replacemen= t value

 <= /span>

 <= /span>

 <= /span>

Other<= /b>

Collateral damage<= o:p>

@ replacement valu= e

 <= /span>

 <= /span>

 <= /span>

Utilities infrastr= ucture

@ replacement valu= e

 <= /span>

 <= /span>

 <= /span>

Business losses

@ replacement valu= e

 <= /span>

 <= /span>

 <= /span>

     Inventory=

@ replacement valu= e

 <= /span>

 <= /span>

 <= /span>

     Prospective in= come

@ replacement valu= e

 <= /span>

 <= /span>

 <= /span>

Mortgage, other de= bt penalties

Actual costs<= /o:p>

 <= /span>

 <= /span>

 <= /span>

Lost/decreased wages/income

Actual losses=

 <= /span>

 <= /span>

 <= /span>

Health care

Actual costs<= /o:p>

 <= /span>

 <= /span>

 <= /span>

Interim housing

Actual costs, or equivalent market value for rent for comparable accommodation donated by others

 <= /span>

 <= /span>

 <= /span>

Bureaucratic and l= egal fees

Actual costs<= /o:p>

 <= /span>

 <= /span>

 <= /span>

Alternative housin= g

Actual costs<= /o:p>

 <= /span>

 <= /span>

 <= /span>

Resettlement<= /o:p>

Actual costs, incl= uding moving, storage, losses in the moving process, transportation and other f= ees

 <= /span>

 <= /span>

 <= /span>

Transportation cos= ts

 Actual costs as a = result of resettlement and additional transport costs to access livelihood and m= eet social needs

 <= /span>

 <= /span>

 <= /span>

Subtotals

 

  

 

 

Victims’ Nonmaterial Losses<= /span>

Health<= /span>

 <= /span>

Living space<= /o:p>

 <= /span>

Reconstruction lic= ensing

 <= /span>

Psychological harm=

 <= /span>

Disintegration of = family

 <= /span>

Loss of community<= o:p>

 <= /span>

Heritage

 

Environment/ecolog= y

 <= /span>

Standing/seniority=

 <= /span>

Political marginal= ization

 <= /span>

Social marginaliza= tion

 <= /span>

Further vulnerabil= ities

 <= /span>

Other

 <= /span>

Other-than-Victims’ Material Costs=

Police<= /span>

 <= /span>

Bulldozers

 <= /span>

Lawyers=

 <= /span>

Army

 <= /span>

Other forces<= /o:p>

 <= /span>

Bureaucratic and p= ersonnel costs

 <= /span>

Other

 <= /span>

Subtotal

 

Other-than-Victims’ Nonmaterial Costs

Social costs<= /o:p>

 <= /span>

Civic order

 <= /span>

Political legitima= cy

 <= /span>

 

Total material costs/losses

 

 

How does the total o= f this material loss compare with the victim’s annual household income?=

 

Total losses ¸ annual household income =3D years of labor &= amp; investment

 

Was the residence oc= cupied at the time of the violation? q Yes  q No.  If yes, explain who was inside and the circumstances of the person(s).

 

Did the perpetrators= give warning before carrying out the violation? Please describe the circumstances, inclu= ding the period of the warning and the actions of the inhabitants.

 

 

 

 

 

&nb= sp;

 

Was anyone injured i= n the course or aftermath of the violation? q Yes  q no=

If Yes, identify those injured:

Name: ---------- ---= ------ ---------  Age: ----  Relationship to residents: -------= ---

Name: ---------- --------- ---------  Age: ----  Relationship to resident= s: ----------

Name: ---------- --------- ---------  Age: ----  Relationship to resident= s: ----------

Name: ---------- ---= ------ ---------  Age: ----  Relationship to residents: -------= ---

[Copy & paste= this section to add lines as needed.]

 

Was anyone killed in= the course or aftermath of the violation?

Name: ---------- --------- ---------  Age: ----  Relationship to resident= s: ----------

Name: ---------- --------- ---------  Age: ----  Relationship to resident= s: ----------

Name: ---------- ---= ------ ---------  Age: ----  Relationship to residents: -------= ---

[Copy & paste= this section to add lines as needed.]

 

Was this home or property previously subject to violation? q Yes  q No  If Yes, please briefly describe those circumstances:

 

 

 

 

&nb= sp;

[Copy & paste= this section to add lines as needed.]

 

 

Is the present state= of the housing unit(s) suitable for habitation? q Yes  q no=

 

Is the housing unit(s) presently occupied? q Yes  q No  If Yes, who presently occupied the housing unit?

Name: ------- ------ ---------  Age: ----  Relationship to original residents: ----------

Name: ------- ------ ---------  Age: ----  Relationship to original residents: ----------

[Copy & paste= this section to add lines as needed.]

 

Otherwise, where are the original inhabitants residing? Briefly describe their circums= tances and tenure in the current residence. Please also indicate if their current tenure is as renters, guests of friends and/or relatives, living in a camp, owners of another residents, etc.:

 

 

 [Copy & paste this section t= o add lines as needed.]

 

 

VI.     &nb= sp; Responses

VI.A     Relief services

Are the victims curr= ently receiving aid from any party? If Yes, is the assistance coming from a government body q a local NGO q an international agency q, or otherq . Please identify the aid organization and the = type of aid provided.

 

Please identify the = aid organization(s) and the type(s) of aid provided.

 

Organization nam= e:        &= nbsp;           &nbs= p;            &= nbsp;    ----------------------------

Contact person:      =             &nb= sp;            =             &nb= sp; ---------- ------- ----------

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Other:        &= nbsp;     ­­­­-------- ------- ------

 

Describe the typ= e of aid or service provided: -----------------------­­­------------= -------

[Copy & paste= this section to add lines for more identifiable parties as needed.]

 

 

VI.B    Media efforts

Has any media agency investigated and/or reported on this case?=   Yes q  = no q  = If yes, name the contact agency and contact person:

 

Name:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  ----------------------------

Title/position:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;   ----------------------------

Media agency:      =             &nb= sp;            =             &nb= sp;   ---------- ------- ----------

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

            =             &nb= sp;            =            Mobile:        &= nbsp;  -------- ------- ------

[Copy & paste= this section to add lines for additional contact persons, if necessary.]

 

 

VI.C    Legal remedy=

Has a legal case bee= n raised by, on behalf of the victims?  Yes  q No  q If the answer is no, or the progress of previous court cases has not delivered the desired results, would you like to raise a court case to remedy the violation?

 

Are victim(s) involv= ed in the case as plaintiffs q or defendants q.

 

Is the dispute being resolved outside of court? If so, by what method? ----------------------

 

If you have not rais= ed a suit, are you considering to do so?  Yes q  N= o q

 

If a current case is= before the courts, please provide some basic details:

 

Case title (with names of prosecuting and defen= dant parties):

 

 

Case number: --------------  Court: -------------  Judicial distri= ct: -------------------

Date filed: --/--/----  Date decide= d: --/--/----  (Settlement date, = if out of court,:  --/--/----)

Presiding judge(s):

(1) ------- ------- = -------- (2) ------- ------- -------- (3) ------- ------- --------=

 

Full name of prosecuting attorney:          &= nbsp;   -------- -------- ---------- 

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

            =             &nb= sp;            =            Mobile:        &= nbsp;  -------- ------- ------

 

Full name of defense attorney:          &= nbsp;         -------- -------- ---------- 

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication number= s:    Telephone:     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

            =             &nb= sp;            =            Mobile:        &= nbsp;  -------- ------- ------

 

Results of case (if any):

 

 

 

Other comment:

 

 

 

Has there been an ap= peal in the case? Yes q No q  N= ot yet q

 =

Would you consider m= ounting an appeal in this case? Yes q No q  W= ill think about it q

=  

VII.      Your certification of the facts

Victim/affected pers= on: ---------------------------  &nbs= p;      Date: --/----/----

        &= nbsp;           &nbs= p;            &= nbsp;                  =         signature

 

Other person filing = this form: -----------------------      Date: --/----/----=

        &= nbsp;           &nbs= p;            &= nbsp;                  =         signature

Relationship to victim/affected person:      -----------------------= -----

Organization:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;   ----------------------------

Position:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           ­= ­­­­­­­­­­­­­­­= ----------------------------

Street address:      = ;            &n= bsp;            = ;            &n= bsp; -----------------------  ----            &= nbsp;          

P.O. Box:      &nb= sp;            =             &nb= sp;            =             -= ------------

City/town/village:        &= nbsp;           &nbs= p;            &= nbsp;         --------------= ---------

District/region:        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; -----------------------

State/country:        &= nbsp;           &nbs= p;            &= nbsp;   -----------------------

 

Communication numbers:    Telephone= :     -------- ------- ------=

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Fax:        &= nbsp;        -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Mobile:        &= nbsp;  -------- ------- ------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  E-mail:        &= nbsp;   ----------------------

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Other:        &= nbsp;     ­­­­-------- ------- ------

 

=  

 

 

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