Housing and Land Rights Violation Case Documentation Form

Housing and Land Rights Violation Case Documentation Form

Housing Rights

I.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  suburban  rural  camp planned and serviced area informal settlement farm house  nomadic housing  forest dwelling 

What is the type of violation? forced eviction  house demolition  denial ofinheritance 

confiscation  damage to home and/or property  environmental degradation other

If other, define the violation: ______

II.Identify affected community/ persons

II.AIf affected persons form a community:

What is the name by which the community is commonly known? ______

Does the community have another name for themselves? What is it? ______

Give the precise location of the affected group or community:

Address/location:______

City/town/village:______

District/region:______

State/country:______

Type of affected area: city  town  village  slum  camp caravan  slum 

informal settlement  planned and serviced area 

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

What is the community’s total population?
What number and/or proportion of the individuals in the community affected?
How many families in the community?
What number and/or proportion of families affected?
In the community, how many affected people are male?
In the community, how many affected people are female?

Also identify the numbers and/or proportions of children, minorities, persons with special needs (medical conditions, disability, elderly) and those subject to historic discrimination:

______

II.BIf affected persons are individuals:

Full name of owner/tenure holder: ______

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

I.D. number: ______Type of document: ______

Complete address of affected housing unit:

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Type of affected area: city  town  village  slum  camp caravan  slum 

informal settlement  planned and serviced area 

Complete current address (if different):

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

Other:______

Sex/gender:Female Male Other

Civil status:single  partneredmarriedseparated divorced widowed

Birthdate:__/_____/____

Full name of spouse (if any): ______

(Additional names, if more than one spouse: ______

______

Names and ages of children:______(age)______

______(age)______

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Refugee status: registered refugeenot registered refugee

Occupation:______Workplace: ______

Address:______

______

Work Tel: ______

Residents:nuclear familyextended family  multiple families

List all residents:______(age)____

______(age)____

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Also identify the numbers and/or proportions of children, minorities, persons with special needs (medical conditions, disability, elderly) and those subject to historic discrimination:

______

Is victim/tenure holder also the household provider? Yes No If Yes, s/he provides for ___ adults ___ children. If no, name provider: ______Is provider also resident? Yes No

If no, give contacts:

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

Other:______

If victim is not owner, identify owner/landlord:

Full name: ______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

Other:______

III.Identifying the means of violation

Cause of loss/damage/destruction: demolition explosives  occupation  vandalism 

pollution  toxic waste  natural disaster  other  (describe: ______)

Means of damage/destruction: bulldozer  gunfire/artillery  airborne missile  rocket gas  tank  other  (describe: ______)

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

Model: ______Country of origin: ______Serial number: ______

Direction of violation (from):  military base military position or checkpoint aircraft

tank military personnel/infantry/militia settlers other ______

IV.Identifying duty holder(s):

Status of principal perpetrator:  private actor public official/officer corporation

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

Full name: ______Title: ______Rank: ______Serial/identification no. ______Police unit: ______

Armed service branch: ______Unit: ______

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Commander/superior officer:

Full name: ______Title: ______Rank: ______Serial/identification no. ______Police unit: ______

Armed service branch: ______Unit: ______

Identity of principal perpetrator, or immediately responsible private party:

corporate official(s) settler(s) other: ______

Name: ______Title: ______Rank: ______Identification no. ______Party represented: ______

Relationship to victim(s), if any: ______

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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:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

Other:______

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

Who gave those reasons?

Full name: ______Title: ______

Position: ______Official position:  Civilian position: 

Employer:

Nationality ______(and citizenship, if different): ______

I.D. number: ______Type of document: ______

Contact information:

Organization:______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

IV.AIdentify duty-holding manufacturer of the destructive means(if appropriate):

Company:______

CEO:______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

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

Company:______

CEO:______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

IV.CIdentify duty-holding local distributor of the destructive means(if appropriate):

Company:______

CEO:______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

V.Documenting consequences:

Which type of tenure victim(s) hold: own rent lease squat

Ground area of structure:_____ square meters

Floor space of residential unit:_____ square meters

Type of property affected:villa  single family home duplex multistory structure

 apartment commercial property kiosk wall/fence plot of land infrastructure other If other, describe: ______

If multiplex or multistory structure, how many storeys? _____ How many units? _____

How many rooms in structure? ____ How many rooms affected? ____

Does the affected housing unit have: kitchen? bathroom? living room? garage?

bedroom? How many? ____

Degree of affect: complete unit(s) no. of units ____ partial no. of units ____

HousingRights Violation “Loss Matrix”

Type and description of cost/loss / Quantification method / Values/
losses / Long-term values/ losses / Totals
Victims’ Material Losses
Structure
Walls / Number and mass (in square meters) @ replacement value
Doorways (frames and doors) / Number (wooden) @ replacement value
Number (wooden & glass) @ replacement value
Number (metal) @ replacement value
Number (metal & glass) @ replacement value
Number (other) @ replacement value
Window frames / Number (wooden frame) @ replacement value
Number (metal frame) @ replacement value
Number (other) @ replacement value
Windowpanes / Size and grade @ replacement value
Roofing / Surface area & material (wooden, shingled) @ replacement value
Surface area & material (concrete) @ replacement value
Surface area & material (metal) @ replacement value
Surface area & material (thatch) @ replacement value
Surface area & material (other) @ replacement value
Infrastructure installations
Heating & cooling systems / Gas heaters @ replacement value
Gas furnace @ replacement value
Oil heaters @ replacement value
Oil furnace @ replacement value
Electric heaters @ replacement value
Electric furnace @ replacement value
Solar heating units @ replacement value
AC units @ replacement value
Central AC @ replacement value
Gas water heaters @ replacement value
Oil water heaters @ replacement value
Electric water heaters @ replacement value
Solar water heaters @ replacement value
Other(s) @ replacement value
Plumbing / Replacement value pipes, drainage, water-delivery system, sanitation & cost of labor to replace
Electrical installations / Replacement value of wiring, fixtures & cost of labor to replace
Other utilities / Replacement values of gas and oil pipelines, fixtures and related installations & cost of labor to replace
Contents
Furniture / Number of beds with mattresses by type @ replacement value
Number of cabinets by type @ replacement value
Vanity & dresser (x number) @ replacement value
Shelving
Sofas (x number & type) @ replacement value
Chairs (x number & type) @ replacement value
Tables (x number & type) @ replacement value
Carpets (by number, type & size) @ replacement value
Decor / Inventory by number and type @ replacement value
Appliances / Television(s) @ replacement value
Computer(s) @ replacement value
Refrigerator(s) @ replacement value
Oven(s) & stove(s) @ replacement value
Clothes washer @ replacement value
Clothes dryer @ replacement value
Sound equipment (recorders, music systems) @ replacement value
Other @ replacement value
Kitchen items / Kitchen appliances @ replacement value
Inventory of dishes, cutlery, cooking utensils, pots & pans @ replacement value
Clothing / Inventory by item and value @ replacement value
Personal items / Replacement values of books, recordings, memorabilia, collections and all personal items lost
Plot / Current market values (before violation)
Plants & vegetation / Houseplants @ replacement value
Shrubbery @ replacement value
Trees / Fruit bearing
Ornamental @ replacement value
Demarcating land @ replacement value
Crops / Number of plants @ replacement value
Harvest value
Animals & livestock
Household pets @ replacement value
Cattle (market value at maturity)
Sheep (market value at maturity)
Goats (market value at maturity)
Poultry (market value at maturity)
Other (market value at maturity)
Vehicles and equipment
Vehicles / Automobile(s) @ replacement value
Utility vehicle(s) @ replacement value
Equipment / Business & office machines
Manufacturing equipment & machines
Cultivation and harvest equipment @ replacement value
Farm equipment @ replacement value
Tools / Farming implements @ replacement value
Other @ replacement value
Other
Collateral damage / @ replacement value
Utilities infrastructure / @ replacement value
Business losses / @ replacement value
Inventory / @ replacement value
Prospective income / @ replacement value
Mortgage, other debt penalties / Actual costs
Lost/decreased wages/income / Actual losses
Health care / Actual costs
Interim housing / Actual costs, or equivalent market value for rent for comparable accommodation donated by others
Bureaucratic and legal fees / Actual costs
Alternative housing / Actual costs
Resettlement / Actual costs, including moving, storage, losses in the moving process, transportation and other fees
Transportation costs / Actual costs as a result of resettlement and additional transport costs to access livelihood and meet social needs
Subtotals
Victims’ Nonmaterial Losses
Health
Living space
Reconstruction licensing
Psychological harm
Disintegration of family
Loss of community
Heritage
Environment/ecology
Standing/seniority
Political marginalization
Social marginalization
Further vulnerabilities
Other
Other-than-Victims’ Material Costs
Police
Bulldozers
Lawyers
Army
Other forces
Bureaucratic and personnel costs
Other
Subtotal
Other-than-Victims’ Nonmaterial Costs
Social costs
Civic order
Political legitimacy
Total material costs/losses

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

Total losses  annual household income = years of labor & investment

Was the residence occupied at the time of the violation? Yes 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, including the period of the warning and the actions of the inhabitants.

Was anyone injured in the course or aftermath of the violation?Yes no

If Yes, identify those injured:

Name: ______Age: ____ Relationship to residents: ______

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

Name: ______Age: ____ Relationship to residents: ______

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

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

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

Name: ______Age: ____ Relationship to original residents: ______

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Otherwise, where are the original inhabitants residing? Briefly describe their circumstances 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.:

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VI.Responses

VI.ARelief services

Are the victims currently receiving aid from any party? If Yes, is the assistance coming from a government bodya local NGO an international agency , orother. 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 name:______

Contact person:______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

Other:______

Describe the type of aid or service provided: ______

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

VI.BMedia efforts

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

Name:______

Title/position:______

Media agency:______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

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

VI.CLegal remedy

Has a legal case been raised by, on behalf of the victims? Yes No 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) involved in the case as plaintiffs or defendants .

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

If you have not raised a suit, are you considering to do so? Yes  No 

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

Case title (with names of prosecuting and defendant parties):

Case number: ______Court: ______Judicial district: ______

Date filed: __/__/____ Date decided: __/__/____ (Settlement date, if out of court,: __/__/____)

Presiding judge(s):

(1) ______(2) ______(3) ______

Full name of prosecuting attorney: ______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

Full name of defense attorney: ______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

Results of case (if any):

Other comment:

Has there been an appeal in the case? YesNo Not yet

Would you consider mounting an appeal in this case?YesNo Will think about it

VII.Your certification of the facts

Victim/affected person: ______Date: __/____/____

signature

Other person filing this form: ______Date: __/____/____

signature

Relationship to victim/affected person: ______

Organization:______

Position: ______

Street address:______

P.O. Box:______

City/town/village:______

District/region:______

State/country:______

Communication numbers:Telephone: ______

Fax:______

Mobile:______

E-mail:______

Other:______