Housing and Land Rights Violation Case Documentation Form

Housing and Land Rights Violation Case Documentation Form

Housing Rights

I. Theviolation

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 suburban q rural q camp q plannedand serviced area q informalsettlement q farmhouse q nomadichousing q forestdwelling q

What is the type ofviolation? forced eviction q housedemolition q denialof inheritance q

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

If other, define theviolation: ------------------------------------------------------

II. Identifyaffected community / persons

II.A If affectedpersons form a community:

What is the nameby which the community is commonly known? --------------------------

Does the communityhave another name for themselves? What is it? ----------------------

Give the preciselocation of the affected group or community:

Address/location: ----------------------- ---------------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

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

informal settlement q planned and serviced area q

What is the community’s size andcomposition? (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 numbersand/or proportions of children, minorities, persons with special needs (medicalconditions, disability, elderly) and those subject to historic discrimination:

------------------------------------------------------------------------------

II.B If affectedpersons are individuals:

Full name of owner/tenureholder: -------------------- ------------ --------------

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

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

Completeaddress of affected housing unit:

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

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

informal settlement q planned and serviced area q

Completecurrent address (if different):

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

Other: --------------- ------

Sex/gender: q Female q Male q Other

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

Birthdate: --/-----/----

Full name of spouse (ifany): --------------------------- --------------

(Additionalnames, if more than one spouse: ---------------------- ------------

--------------------- ------------

---------------------- ------------

Namesand ages of children: ---------------------- (age)--------

---------------------- (age)--------

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Refugee status: q registeredrefugee q not registered refugee

Occupation: ------------------- Workplace: -----------------------

Address: -----------------------

-----------------------

WorkTel: ------ ------ ------

Residents: q nuclear family q extended family q multiple families

Listall residents: -------------------- ---------- (age)----

-------------------- ---------- (age)----

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

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Is victim/tenure holder alsothe household provider? q Yes q No If Yes, s/he provides for --- adults --- children. If no, name provider: --------- ------------- Is provider also resident? q Yes q No

Ifno, give contacts:

Street address: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

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

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

Other: --------------- ------

Ifvictim is not owner, identify owner/landlord:

Fullname: ------------------ ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

Other: --------------- ------

III. Identifyingthe means of violation

Cause ofloss/damage/destruction: demolitionq explosives q occupation q vandalism q

pollution q toxicwaste q naturaldisaster q other q (describe:--------------------)

Means ofdamage/destruction: bulldozer q gunfire/artilleryq airbornemissile q rocket q gas q tankq other q (describe: ---------------------------------------------)

Identifytype and origin of destructive means: Brand/company of manufacture: --------------

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

Direction of violation(from): q militarybase q military position or checkpoint q aircraft

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

IV. Identifyingduty holder(s):

Status of principalperpetrator: q privateactor q public official/officer q corporation

Identity of principalperpetrator, or immediately responsible public official/officer:

Fullname: --------- --------- ---------- Title: ---------- Rank: ---------- Serial/identification no.------------------- Police unit: ----------

Armed service branch: ------------------- Unit: ----------------

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Commander/superiorofficer:

Fullname: --------- --------- ---------- Title: ---------- Rank: ---------- Serial/identification no.------------------- Police unit: ----------

Armed service branch: ------------------- Unit: ----------------

Identity of principalperpetrator, or immediately responsible private party:

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

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

Relationship to victim(s),if any: -------------------

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Whoordered the violation (if different from principal perpetrator)?

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

Nationality (andcitizenship, if different): -------------------

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

Completeaddress:

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

Other: --------------- ------

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

Whogave those reasons?

Full name: -------------------- ------------ -------------- Title: -----------

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

Employer:

Nationality ------------------- (and citizenship, ifdifferent): -------------------

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

Contactinformation:

Organization: ----------------------------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

IV.A Identify duty-holdingmanufacturer of the destructive means (ifappropriate):

Company: ----------------------------

CEO: ----------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

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

Company: ----------------------------

CEO: ----------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

IV.C Identify duty-holding localdistributor of the destructive means (ifappropriate):

Company: ----------------------------

CEO: ----------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

V. Documentingconsequences:

Which type of tenurevictim(s) hold: q own q rent q lease q squat

Groundarea of structure: -----square meters

Floor space of residentialunit: -----square meters

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

q apartmentq commercial property q kiosk q wall/fence q plot of land q infrastructure q other If other, describe:------------------------------------------------------

If multiplex or multistorystructure, how many storeys? ----- How many units? -----

How many rooms in structure?---- How many roomsaffected? ----

Does the affected housingunit have: q kitchen? q bathroom? q living room? 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”
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 thismaterial loss compare with the victim’s annual household income?

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

Was the residence occupiedat the time of the violation? q Yes q No. Ifyes, explain who was inside and the circumstances of the person(s).

Did the perpetrators give warningbefore carrying out the violation? Please describe the circumstances, includingthe period of the warning and the actions of the inhabitants.

Was anyone injured in thecourse or aftermath of the violation? q Yes q no

IfYes, identify those injured:

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

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

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

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Was anyone killed in thecourse or aftermath of the violation?

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

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

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Wasthis home or property previously subject to violation? q Yes q No IfYes, please briefly describe those circumstances:

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

Isthe housing unit(s) presently occupied? q Yes q No If Yes, who presently occupied thehousing unit?

Name:------- ------ --------- Age:---- Relationship to originalresidents: ----------

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

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Otherwise,where are the original inhabitants residing? Briefly describe their circumstancesand tenure in the current residence. Please also indicate if their currenttenure 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.A Relief services

Are the victims currentlyreceiving aid from any party? If Yes, is the assistance coming from agovernment body q a local NGO q aninternational agency q, or otherq . Please identify the aid organization and the typeof aid provided.

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

Organization name: ----------------------------

Contactperson: ----------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

Other: --------------- ------

Describe the type ofaid or service provided: ------------------------------------------

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

VI.B Media efforts

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

Name: ----------------------------

Title/position: ----------------------------

Mediaagency: ----------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

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

VI.C Legal remedy

Has a legal case been raisedby, on behalf of the victims? Yes q No q If the answer is no, or the progress of previouscourt cases has not delivered the desired results, would you like to raise acourt case to remedy the violation?

Are victim(s) involved inthe case as plaintiffs q or defendants q.

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

If you have not raised asuit, are you considering to do so? Yes q No q

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

Case title (with names of prosecuting and defendantparties):

Casenumber: -------------- Court:------------- Judicial district:-------------------

Datefiled: --/--/---- Date decided:--/--/---- (Settlement date, if outof court,: --/--/----)

Presidingjudge(s):

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

Fullname of prosecuting attorney: ---------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

Fullname of defense attorney: ---------------- ----------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

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

Fax: --------------- ------

Mobile: --------------- ------

Resultsof case (if any):

Othercomment:

Has there been an appeal inthe case? Yes q No q Not yetq

Would you consider mountingan appeal in this case? Yes q No q Willthink about it q

VII. Yourcertification of the facts

Victim/affected person:--------------------------- Date:--/----/----

signature

Other person filing thisform: ----------------------- Date: --/----/----

signature

Relationshipto victim/affected person: ----------------------------

Organization: ----------------------------

Position: ----------------------------

Streetaddress: ----------------------- ----

P.O.Box: -------------

City/town/village: -----------------------

District/region: -----------------------

State/country: -----------------------

Communicationnumbers: Telephone: -------- ------- ------

Fax: --------------- ------

Mobile: --------------- ------

E-mail: ----------------------

Other: --------------- ------

Housing Rights Violation “Loss Matrix”