Collection of Death Certificates and Detainee Autopsy Summaries from Iraq and Afghanistan

<p>Collection of 25 death certificates and summary of 30 detainee autopsy reports from Afghanistan and Iraq. Full autopsy reports can be found at ACLU RDI 991-1018.</p>

Doc_type: 
Medical
Doc_date: 
Thursday, September 23, 2004
Doc_rel_date: 
Sunday, April 17, 2005
Doc_text: 

CERTIFICATE OF DEATH (OVERSEAS) Acte de &Wes (D'Outre-Mer) NAMF OF DFCFASFD fine , 6)(6)4 Firm Middle) Nom du deckle INom at prenoms) GRADE Grade CIVILIAN BRANCH OF SERVICE Arme N/A SOCIAL SECURITY NUMBER Numdro de ('Assurance Sociale ORGANIZATION Organisation NATION (e.g.. United States) Pays AFGHANISTAN DATE OF BIRTH Data de naissanca AGE APPROX. 35 YRS SEX Sexe Pi MALE Masculin • FEMALE Feminin :6)(3)-1 BCP, BAGRAM AIR FIELD, AFGHANISTAN RACE Race MARITAL STATUS etat Civil RELIGION Culte CAUCASOID Calcasieu. SINGLE Cdlibataire DIVORCED Divorce PROTESTANT Protestant X OTHER (Specify) Autre (Specifier) MUSLIM NEGROID Negroids X MARRIED Marie CATHOLIC Cathaque SOpardATED X OTHER ISpecify1 Autre (Specifier) WIDOWED Veal JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decode avec le susdit FATHER (b)(6)-4 STREET ADDRESS Domicile 6 IRual CITY OF TOWN AND STATE (Include ZIP Code) Ville (Code postal compris) , MEDICAL STATEMENT Declaration marketer CAUSE OF DEATH (Enter only one cause per line) Cause du deeds IN'indiquer qu'une cause par ligne) Intervale antra INTERVAL BETWEEN ONSET AND DEATH cettaque et le ddcds DISEASE OR CONDITION DIRECTLY LEADING TO DEATH ( Maladie ou condition directement responsable de la mart! BLUNT FORCE INJURIES TO LOWER EXREMITIES COMPLICATING CORONARY ARTERY DISEASE \ A;ANTECEDENT CAUSES Syrnptomes precurseurs de la mort. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbid.. s'il y a lieu, menent 6 la cause primaire UNDERLYING CAUSE, IF ANY. GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'il y a lieu, avant suscite la cause primaire OTHER SIGNIFICANT CONDITIONS 2 Autres conditions signiticatiyes2 MODE OF DEATH Condition de deeds ' AUTOPSY PERFORMED Autopsie effectude I33 YES Oui III NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO Circonstances de la mmoortsuscitees par des causes @measures DECEDENT WAS FOUND UNRESPONSIVE IN HIS CELL WHILE IN CUSTODY EXTERNAL CAUSES MAJOR FINDINGS OF AUTOPSY Conclusions principalea de l'autopsie NATURAL Mort natural!. ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du pathologist. 63)(6)-2 MM, MC, USAF XA (b)(8)-2 HOMICIDE Homicide SIGNATURE Signature DATE Date 13 DEC 02 AVIATION ACCIDENT Accident 0 /Mon li YES Oui FA. NO Non DATE OF DEATH (Hour, day, 11101I year) Data de deck (Piteure, le jour, k mots, l'aruele) PLACE OF DEATH Lieu de deeds BCP, BAGRAM AF,AFGHANISTAN I HAVE VEIWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les routes mortals du ddfunt at jer conclus qua le dears est survenu a l'heure indiquee at 0, la suite des causes dnumerdes ci dessus NAMF CIF MFDICAi ncFirco hi A •dicin militaire ou du mddicin sanitaire TITLE OR DEGREE Titre ou diplarnd ARMED FORCES REGIONAL MEDICAL EXAMINER N(S)- LTC (P), MC, USA GRADE Grade '-',— \. LTC (P) INSTALLATION OR ADDRESS Installation ou adresse LANDSTUHL REGIONAL MEDICALCENTER t Date 13 DEC 02 S b)(6)-2 1 State disease, injury or complication which ea 2 State conditions contributing to the death, but not retatea to the atsatse or conchiton causing death. ' Precise, la nature de la =ladle. de to blessure ou de la complication qui a contribut O la inert mals non la maniere de nsourir. relic qu'un anti du coeur, etc. 2 Plebe, la condition qui a contribue a la mort mass n'ayant cutout rapport awe la =ladle ou a la condition qui a provoque Is more DD FORM 2064, APR 1977 REPLACES DA FORM 3585, 1 JAN 1972 AND DA FORM 3565-RIPAS), 28 SEP 1976, WHICH ARE OBSOLETE. USAPA V1.00 MEDCOM - 169 2859183 DOD 003296 CERTIFIC -or ooti{ riveRt Act ATE tiees' Ovot t rO-ree kas) . __. . • . . • d ME OF DECEASED (Last, First, Middle) Nom du decode (Nom et prertoma) ' ' GRADE tirade . BRANCH OF SERVICE Arme SOCIAL SECURITY NUMBER, : Pittner° de ('Assurance Sociale • -8)(6)-4 ORGANIZATION otganisation Afghanistan Detainee NATION (e.g.. 'United States) i Pays Afghanistan DATE O BIRTH Date de naissance SEX &hie .11.0 MALE Masedlit FEMALE Feminin RACE Race • 'MARITAL STATUS Etat Civil RELIGION Cute .CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce , PROTESTANT •Picitestant OTHER (Specify) ',twee (Specifier) , NEGROID Negriode MARRIED ,Marie CATHOLIC Catholique SEPARATED Ware OTHER (Specify) Aube(Specifier) WIDOWED Veul JEWISH Juil NAME OF NEXT OF KIN Nem du plus proche parent RELATIONSHIP TO DECEASED Parente du decede avec le su tit STREET ADDRESS Domicile A:(Rue) CITY OR TOWN,AND STATE (IncludeZIP Code) ,Ville (Code postal compre) MEDICAL STATEMENT Declaration medicate CAUSE OF DEATH (Enter only once cause per line) Cause du aces (Nindiquer qu'une cause par tone) INTERVAL BErlyE,tN ONSET AND DEATH Intervaiie entre rettaque et le-deces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH( Maladie ou condition directement responsible de In molt? Blunt Force Injuries to Lower Extremities Complicating Coronary Artery Disease ANTECEDENT - Sympternes precurseurs de la mod. MORBID CONDITION, IF. ANY, LEADING TO PRIMARYCSAUE Condition morbide, s'il y a lieu. menant Ala cause primaire ) UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'il y a lieu, ayant suscitl la cause. primaire OTHER SIGNIFICANT CONDITIONS 2 Awes conditions significatives MODE OF DEATH Condition de deeds AUTOPSY PERFORMED Autopsie effectuee RYES Oui n NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mort suscitees par des causes exterieures ' MAJOR FINDINGS OF AUTOPSY Conclusions principalis de l'autopsie 1 NATURAL Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du Patholoaiate 8)(8)-2 I LICOI, MC, USAF x — HOMICIDE Homicide SIGNATURE E610)..2 DATE Date 13 Dec .2002 AVIATION ACCIDENT Accident A'Avion • YES Oui Er NO Non DATE OF DEATH (Hour day, month, year Da e de dines Sheure, q lour, le mois, le ATH Lieu de deces 0200, 10 Dec 2002 Bag ram Collection I HAVE VIEWED THE REMAINS OF THE DECEASED AND.DEATKOCCURRED-AT.THE TIME INDICATED AND FROM THE CAUSES AS STATED .ABOVE. J'al examine leerestes mortals du de hintst je conclus quo le caves est survenu A l'heure indiquee et A, Is suite des causes Imumerees ci-dessu& rNAME OF MEDICAL OFFICER Nom du medicin militaire ou du medicin sanitaire )(8)., TITLE OR DEGREE Tilre ou diplorne First Chief Deputy Medical Examiner GRADE Grade ... '' C.$ ol INSTALLATION OR ADDRESS Installation ou ad ease Dover AFB, DE 19902 ,':E Date .-• .2 6 041 0 S,'8)(6)-2 - l Stale disease, injury or complication which C8 State conditions contributing to the death, but not related to the diseaSe or condition causing death. 1 PreSser la nature de la maladie, de is blesiure ou de la complication qul a contribue a la mori, M81.8 non la Maniere de mourir, tells qu un erre du coeur, etc 2 Precisir Is condition qui econtribuo a la mort, mais n'ayant aucun rappOrt avecla maladie Ou iecondllioaqui a provoque la mort. DD,FrA2064 REPLACES DA FORM 35650 JAN 72 AND DA FORM 3565-E(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 170 DOD 003297 p.3 Ma M 19 04 10:48a , . . CERTIFICATEDF.DEATH (OVERSEAS). Acte de dices(D'Ontre-Mer) NAME OF DECEASED (Lou. Fin!. lrfirklir) Non, du decade (Nom ei prdnoms) GRADE Grade BRANCH OF SERVICE Atma DATE OF BIRTH Maio d. nal SOCIAL SECURITY NUMBER Niondro de l'Aiicurance Socialc ..... SEX Seas ps MALE Mascutin . 0 FEMALE Ferninin bX87-4 CIV - • NATION (e.e.. Irbdwrl Sour) 'aye : AFGHANISTAN ORGANIZATION Organiselion AFGHANISTAN CIVILIAN RACE Rasa MARITAL STATUS Elan CiVII RELIGION Cate' - X ,.._ . •CAUCASOID Caucasigue . SINGLE ...Celibalnite . DIVORCED Diveree PROTESTANT Pt otestent !OTHER (Specify) Auto., ININInfiril UNKNOWN _... ...NEGROID . Nog ! MARRIED Mane CAT HOLIC Catholiqu• ,OTHER (Specify' UipPaA,I:A TED Aisne (SpriVier) WIDOWED Voul - • - • JEWISH Juif NAME OF NEXT OF KIN Nom du plus premise parent RELATIONSHIP TO DECEASED Parente du deckle avec le susdit STREET ADDRESS Oornicild a 'Rue) CITY OF TOWN AND STATE (bOW, ZIP Cod,/ Ville Mode postal coMpris I MEDICAL STATEMENT . ._Deeltriatliin.Madierile CAUSE OF DEATH rake, only use mise pee linri Cause du dechs'IN'indiquer qu'Une cause. par lignal INTERVAL BETWEEN ' ONSET AND DEATH, Inevale•entre partoque et le decet , . . DISEASE OR CONDITION 'DIRECTLY LEADING TO DEATH ' Maladie so condition directeinent rasponsable de le•rnort: . . . . . • • •MULTIPLE i3LUNT FORCE INJURIES COMPLICATED BY PROBABLE RHABDOMYOLYSIS ANTECEDENT CAUSES SYMPlaloe. priCluseurs de I. moth. MORBID CONDITION. IF ANY, LEADING TO PRIMARY CAUSE Condition morbid., sal y. a lieu. minim A.lanause:ptImalre ... UNDERVIING .CAUSE, IF ANY, GIVING RISE TO PRIMARY . • CAUSE ayant suseite la cauterptirnalre Raison I ondarnentale, 01 y a lieu. OTHER SIGNIFICANT CONDITIONS Alines edneitions s/pnilleatives 2 MODE OF DEATH Condition de dices AUTOPSY PERFORMED Autopsie eflectuee MAJOR FINDINGS OF AUTOPSY Conclusions EN YES Oui 111 NO Non principsles de Fautopsie CIRCUMSTANCES SURROUNDING EXTERNAL CAUSES - Circonstanaaa de.la molt suscitoes DEATH DUE TO • - . ears NATURAL Men naturelle par causes oarterieures ACCIDENT - Mort accidentelle SUIC ID E NAME II; PATHIIIGIUcT Sinn. ,1111...1..1...i... . Suicide b)(6)-2 LTC(P), USA, MC HOMICIDE X Homicide DATE b)(6).2 D•ie 13. NOV 2003 AVIATION ACCIDENT Accident 2 Avion III YES Oui - El GATE OF DEATH (Hour. nn 11100111. year Dote de dotes II lienre; If jaw, le niois. l' O)j6)-2 ' • NO Non PLACE OF DEATH Lieu de dies • .' - 143fEL 6 NOV 2003 ._ _ .. HELMAND PROV NCB, -AFGHANISTAN I HAVE VEIWED THE REMAINS OF THE DECEASED-AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. - J'ai-examine les t mortals -du.detunt et•je conclus que le dikes not survenu a Fheure indiquire-et.i. la suite des causes enurnerees ci dessus ISAME OF MFDICAL OFFICER Men •lu meificin rsIilinire Fn.. Iini ini. diciel its,vileiie LTC(P). 08A, MC TITLE OR DEGREE Thew uu iliiilenta • ARMED FORCES REGIONAL MEDICAL EXAMINER • GRADE Grade 1—TC(P) / 0-5. .__ INSTALLATION OR ADDRESS Installation Oil a.. dreae.- BAGRAM. AIR. FIELD, AFGHANISTAN DATE Date . . . 1 3. NOV 2003 -00)-7 . , Smite &Jew, ions or romplicolou whir 2 Sme rinnlkion.: rnJeriboring to dre rIrruh. . ' POritor In UAW, de In ieniiWie. 0, is MI de In rump:rm.:um nni n rolnohne n In mar:. nods non In innin1r/ dr- 'amok !elle 411-V1 nrn.,11: Men.% Cr 2.. FIRM, In rowlifion -nni 11.COnfillnd.6 In IOW. "fah lenynnf Winne irpport ewer In nInknlir an it In rnordinion ani Sr prO•Wild In now. , JAN 71.007722 ANDOA FORM 3565-RIPAS), 26 SEP 1575, WHICH ARE OBSOLETE. USAPA V I.00 , MEDCOM - 171 DOD 003298 Ha-y. 20 04 08',:-560 1(6)(3)-1 p . 4 CERTIFICATE OF DEATH (OVERSEAS). Acte de &elm (D'Outre-Mer) NAME OF DECEASED arm Fir% MuJ4/41. Nemdu deckle (Nem es venoms/ • • - - • - - GRADE Grad. . . BRANCH OF SERVICE ArMe SOCIAL SECURITY NUMBER , NurndrO di l'Aisurence * Ila./4 Sect Nina ON Orpenismion NATION DATE OF .BIRTH , 'SEX Saxe CII MALE - Masculin ... NI FEMALE Famine", r ' fr.s„ Unfired Srale.9 Pais , . AFGHANISTAN . . Dam do naimance APPROX 1974 BCI): .BAGRAIVI AIRFIELD; AFGHANISTAN RACE . Race MARITAL, STATUS Etat.cia RELIGION, Cul!! CAUCASOID , . Caucasian. . SINGLE Cflibataili . DIVORCED Divence . PROTESTANT Predislant OTHER (*rob,' r AO. (Speeliliri MUSLIM NEGROID Niprdide MARRIED Mane_ . - - -. CATHOLIC --- • -- X OTHER ISpecily) A Aut. (Specifier; PASHTUN WIDOWED Viol. SEPARATED Sat.. JEWISH Juil NAME OF NEXT OF KIN Nom du plus, macho parent RELATIONSHIP TO DECEASED . Parente do decade avec le susdit ,b)(6)-4 FATHER I STREET ADDRESS Domicile I (Fluel CITY OF TOWN AND STATE rhichuir, ZIP Cu4r) .. Ville (Code postal comoris) MEDICAL STATEMENT Decimation medical, CAUSE DF.DEATH (Ease, oily one come per hue), . Cots. du_ Micas (N'indiquer attune cause pat lions) INTERVAL BETWEEN ONSET ANL) LUEATH Intone/Ale int. rinsacpie in le daces DISEASE, OR CONDITION DIHEC I LY LEADING TO DEATH : Maladie us condition directemans responsible de la morn. . . PULMONARY EMBOLISM DUE TO BLUNT FORCE INJURY TO THE LEGS ANTECEDENT CAUSES Symptom,. precurseurs de la mon. MORBID CONDITION, IF ANY, LEADING 70 PRIMARY CAUSE Condition montide, s'il y a lieu. merlons 1 la eau.. prima). ' UNDERLYING CAUSE, IF ANY, GIVING RISE TO .PRIMARY CAUSE Raison landementale, s'il y • lieu, sirens 31.01 I. cause.primeira DTHER SIGNIFICANT CONDITIONS Autres conditions significalitMs2 ' MODE OF DEATH AUTOPSY PERFORMED AutopsiaolfectUdm in YES Oui 0 NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la more ,sussitees par des causes exterieures DF.CEDF.NT WAS FOUND UNRESPONS7VE IN HIS CELLWHILE IN CUSTODY Condition de-daces .L.. MAJOR FINDINGS.OF AUTOPSY Conclusions principals, de, l'eutop.sie . NATURAL , Mort naturelle ACCIDENT Mart ,accidoretelle- SUICIDE NAME OF PATHOLOGIST No du palholoolsi. Suicide . p)(6)-2 I LTC (P), MC, USA HOMICIDE , Homicide dip-2 DATE Date 8 DEC 02 AVIATION ACCIDENT Accident a Avian MI YES Oui FIR NO Non DA. E OF DEATH (NOW Dalq de dices (Hinny - 41 Lieu de delis AFGHANISTAN . _ . _ .• 2014Z,.3•DEC OZ Bcr, ks ALA.* AF, I HAVE VEINED THE REMAINS OF THE,DECEASED ANDDEATROCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. .raelsarin# los rossea . monels du dalunt et je canonic quo I. daces out Stevens I I'h.u.e iodic.. it e„ le stile des saunas oilnuni.eesci doss,. NAME OFMME DICAL OFFICER Non, du medicin miEtaire ou do Median sanitairee TITLE OR DEGREE Tito nu diplorrie ARMED FORCES REGIONAL MEDICAL EXAMINER [0072 - • ' LTC- CP), MSA• • GRADE Grade LTC (P) ' INSTALLATION . OR ADDRESS installation au adresse LANDSTUHL REGIONAL MEDICAL. CENTER DATE Date ' 14 DEC 02 (b)(8)-2 ' Pak dinasr, injury or turnplicusiun add; 2 Sicily iuruaiints coliffibiitiug in die death; ' prOciiri irci nature de Ed itidthdie, de Id bfitis,re nu cm iv n onymmomon gm si CuirinDue a M mart mauve.,,, ru mandlr de rlr. Idle eitiun tun,/ du earn,. vs, 2 riel.4I 61candislun qui ii'iimil'Inif! Jig, uid n,Iriiiii iiiivani usain itipi;rirra n14- Iiiirkiludir MI d hi ruiiditiun qui II piiiiivejueld niiin. , APR 1977 REPLACES DA FORM 356S, 1 JAN 1972 AND OA FORM 3555-RIPASI. 26 SEP 1975. WHICH ARE OBSOLETE. USAPA V1.00• MEDCOM - 172 DOD 003299 CERTIFICATE OF DEATH (OVERSEAS) •Acte.de. aces (0 •04tre-Merl NAME OF DECEASED (Last, First, Middle) Nom du decode (Nom at prenoCmEsR) GRADE Grade BRANCH OF SERVICE Arme SOCIAL SECURITY NUMBER b)(6 )-4 Numero de !Assurance Social° .ORGA NIZATION Organisation Detainee in Iraq NATION (e.g., United States) Pays Iraq DATE OF BIRTH -Date de naissance- SEX Seise Ei MALE Masculin FEMALE Ferninin RACE Race MARITAL STATUS Etat Civil RELIGION C ul.te . X CAUCASOID Caucasique SINGLE Celibalaire • ' ' DIVORCED Divorce CATHOLIC PROTESTANT Protestant . . . OTHER..(Specily) Autre (Specifier) NEGROID Negriode MARRIED Marie Catholique SEPARATED OTHER (Specify) Ware Autre (Snecifier), WIDOWED Veul JEWISH Juif NAME OF NEXT OF KIN Nor du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec le su dit . STREET ADDRESS Domicile A (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Vile (Code postal compris) MEDICAL STATEMENT peclaratkin medicale CAUSE OF DEATH (Enter only once cause per line) Cause du daces (Nindiquer qu'une cause par bone) INTERVAL BETWEEN . ONSET ANC DEATH , . Intervalleentre Ignatius at le deces DISEASE.OR CONDITION DIRECTLY LEADING TO DEATH ( Maladie ou condition directement responsahle de la morti.. Pending ) ANTECEDENT CAUSES ..,,( Synipternes precurseigs de la molt. MORBID CONDITION. IFANY, LEADING TO PRIMARY CAUSE Condition morhide, s'il .y a lieu. ' rnenant a la cause primaire UNDERLYING CAUSE. IF ANY. GIVING RISE TO PRIMARY CAUSE Raieon fondamentale, s'il y a lieu, ayant suscite la cause primaire OTHER SIGNIFICANT CONDITIONS 2 Autres conditions signilicatives MODE OF' EATH Condition de dealt& AUTOPSY PERFORMED Autopsie ettectuee RYES Oui ntiO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de.la molt suscitees par des causes exterieures Mode of Death: Pending MAJOR FINDINGS OF AUTOPSY Conclusions Principales de lautopsie NATURAL Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nor du pathologiste .13)(8)-2 LtCol, MC, USAF HOMICIDE Homicide SIGNATURE Signature DATE Date 26 Apr 2004 AVIATION. ACCIDENT Accident A &don b)(8)-2 • YES Oui M NO Non DATE OF DEATH (Hour a ,..r.. t OF DEATH Lieu de daces Date de daces (theure, le lour; le mi.'s', fannee) I 05 Apr 2004 Iraq - I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. Jai examine Ms Testes models du de luntet je conclus que le daces est survenu a l'heure indiquee et a, Ia suite des causes enumerees ci-dessus. NAME OF MEDICAL OFFICER Nom du medicin militaire ou du medicin sanitaire TITLE OR DEGREE Titre ou diploma First Chief Deputy Medical Examiner (b)03)-7' GRADE Grade Col . INSTALLATION OR ADDRESS Installation ou adresse Dover AFB, DE 19902 . E Date .. SIGNATURE _Signature )1 Aix CI I State diserrie, inirey or corriPlication whicHeaused death, but not MEde of dying such as heartlearke„etc, 2 State conditions contributing to, the death, but not related to the disease or condition causing death. , , I Presser Ia nature de is maladie. de la blessure ou de la complication qui a contribue A la mort, mais non Is maniere de mourir, telle qu 'un arras du coeur, etc 2 Preciser Ia condition qui a contribue Ala molt, mais n'ayant aucun rapport avec Ia =ladle ou A la condition qui a pro vogue la mod. DD 1 FACM7 REPLACES DA FORM 3565, I JAN 72 AND DA FORM 3565-RIPAS). 26 SEP 75. WHICH ARE OBSOLETE. MEDCOM - 173 DOD 003300 P • 6 Maw 20 04 02:56p • CERTIFICATE OF DEATH (OVERSEAS) Acta de daces (D'Outre-)Ner) NAME OF DECEASED (but. Fin:. Middle) Nom du decade (Nom el venom) GRADE Grade BRANCH OF SERVICE . .. Acme CPT DETAINEE SOCIAL SECURITY NUMBER • - 6 0)4 Numero no TAssurance Secede ORGANIZATION Organiselion NATION (e.g.. Unirer/Snuer) Pays IRAQ • DATE OF BIRTH Dale de nalasence SEX Seee g7 MALE Mssculin 1111 FEMALE Feminin DETAINEE NUMBER: *" RAGE Race MARITAL STATUS EMI-Civil . RELIGION Culle CAUCASOID Cau casique SINGLE CAlibalalre DIVORCED - Divorce PROTESTANT Nolte:tont OTHER (Spurify) Au.irc (Specified NEGROID. • • Negritude MARRIED. .. Marie • 2:74Z5 SEPARATED Sepal XX OTHER. (Speedy) &Me (5micifin) WIDOWED Veut UNKNOWN JEWISH JO NAME OF NEXT OF TON Nom du. plus proche perenl RELATIONSHIP TO DECEASED Parente di decade aver iesuscle STREET ADDRESS Domicile a (Rue) CITY OF TOWN AND STATE (Include ZIP Codr) Via. (Code posIdl dompris) MEDICAL STATEMENT Declaration medicate CAUSE OF DEATH (Ewer only ono come per line) . Cause du daces (Nlndiquer mAine cause par lignej INTERVAL BETWEEN ONSET AND DEATHinterealte entre rummer at le daces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH' Melodic ou condition dIrectemeni responsabie de la ,, 1 STRANGULATION ANTECEDENT CAUSES . MORBID CONDITION. IF ANY. ' LEADING TO PRIMARY CAUSE Condition Morbide, ea y a lieu. meront ! le cameo primaim SymplOmes precumeuM • de la med. UNDERLYING-CALISE..IF ANY. GIVING RISE TO PRIMARY CAUSE - . • Ralson lonelamenlale. VII y a .Seu._ avant suselle Is cause grimace OTHER SIGNIFICANT CONDITIONS ' Aulres condilonsIgnidsalves MODE OF DEATH ...Condition - de daces AUTOPSY PERFORMED Aulopale effeeluee El YES . Dui 0 NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EtTERNAL-CAUSES' • CITconstanceS da la mart suscilses par des causes ealeneures DECEDENT FOUND UNRESPONSIVE IN OUTSIDE ISOLATION; WHITEHORSE DETAINMENT FACILITY MAJOR FINDINGS OF AUTOPSY Conclusions principales de Taulopsle • NATURAL Mon naturelle ACCIDENT • Mai accidenlelle SUICIDE NAME OF PATHOMGAT Noun rlii 11.ihnligirta . 514Cide 10(6)-2 LTC(P), USA, MC HOMICIDE, Homicide ( X6)-2 . DATE Dale . 10 JUN 2003 AVIATION ACCIDENT AOCidelll a Aviion - DATE OF DEATH (Hour. day. month. year,. 1-1 YES Out El. NO Nan Dide de decks (Plicurc. !Ono: ic mac. l'annOc), b)(8)-2 ,, PLACE OF DEATH Lieu de deces , ..1230, 6 JUNE 2003 NASYRAH, IRAQ I HAVE VEIWED THE. REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. -Eel examine les resIes Models du defiant el Je conclus due . le daces est sureenu b Theure indiquee es A. Ia suite des causes enurnereas el dessus NIE CIF k4Frwrof napirme ainm-- dl. me inalleiro ou du modIclo- sonitOro b) )-2 'ILTC(P), USA, MC TITLE OR DEGREE Titic OV dip' me ARMED FORCES REGIONAL MEDICAL EXAMINER GRADE Grade LTC(P) / 0-5 INSTALLATION OR ADDRESS Insiallation ou edresse LANDSTUHL-REGIONAL MEDICAL CENTER, APO AE 09180 I I DATE Dale . .. _ 1 0- JUNE 2003 'MP , Stoic dimes, Inforyar complication Ivilich 2 State conditions contributing so rhe death b 1 'Prii.Ittr la nratiro de 14 nailndis. doll* qaF.i...... de In conipliciaionZria citnfrin Ye a !a mart cacti; non to maniere de in toilet Wan mat do coc.. arc. . 2. Plifsea in'eVixlftion qua a Conteibui it 14 inoiri.'inti ii n'ayanfatka n nippari avec In ntniadit au h In condition qui h pr.?, tie Io won., nn 'PARRA InaA ano 1077 r 1 JAN-1972 AND DA FORM ( ,26 SEP 1975, WHICH ARE OBSOLETE. USAPA V1.00 MEDCOM - 174 DOD 003301 Acte de aces (D'Outre-Mer) It, CERTIFICATE OF DEATH (OVERSEAS) NAME OF DECEASED (Last. First, Middle) Nom du dOcede (Nom et prenrims) ., - GRADE Grade, .' . BRANCH OF SERVICE Arme SOCIAL SECURITY NUMBER • . bX6)Y-44 Numera de I Assurance Sociale f ORGANIZATION Organisation NATION (e.g.. United States) Pays Iraq DATE OF BIRTH Datede naissance. 01 Jan 1960 SEX Soon r MALE Mascelin FEMALE Feminin RACE Race MARITAL STATUS Etat Civil RELIGION Culte X CAUCASOID Cau c,asi que- , ' SINGLE Cetilailaire. . . DIVORCED Divorce PROTESTANT Protestant OTHER (Specify) Antra (Specifier) CA THO LIC NEGROID Negriode MARRIED Marie Catholique SEPARATED Separe - JEWISH Juil , ., OTHER (Specify) AO° (Specifier) WIDOWED Veul NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec le su dit STREET ADDRESS Domicile a (Rue) CITY OR TOWN AND STATE (Include ZIP Ccide) Ville (Code postal compris) MEDICAL STATEMENT Declaration mei:Scale . CAUSE OF DEATH (Enter only once cause per line)- Cause du dimes (N'indiquer qu'une cause par lire) INTERVAL BETWEEN ONSET AND DEATH ,Intervalle entre rettaque et le ages I DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable de la more. Multiple gunshot wounds with complications ' Days ANTECEDENT CAUSES Symplpmes precurseurs de la Mort. •MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, sit y a lieu. menant e la cause primaire UNDERLYING- CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, ail . y a lieu. ayard suScite la cause primaire - OTHER SIGNIFICANT CONDITIONS 2 Autres conditions significativee MODE OF DEATH Condition de (feces AUTOPSY PERFORMED Autopsie effectuee YES Oui nNO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO MAJOR FINDINGS OF AUTOPSY Conclusions principalet de l'autopsie EXTERNAL CAUSES Circonstances de la mart suscitees par des causes exterieures NATURAL Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du petnotogiste re)? CDR, kic, USN X HOMICIDE Homicide X6 DATE Date 18 M, ay 2004 .. _ AVIATIONACCIDENT Accident a Avian • YES Oui ty, NO Non •DATE OF DEATH ( Date dedeces (/710 28 Apr 2004 EATH' Lieu de aces , .-.0.,,I.X6)-7 Baghdad, leaq I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES ASSTATED ABOVE. J'ai examine les restes mortels du de funtet je conctus que to dimes est suivenu A rheure indiqUee et a, In suite des causes 'enumenfreeci-dessus. NAME OF MEDICAL OFFICER Nom du medicinInilitaire ou'du medicin sanitaire TITLE OR DEGREE Titre ou dipleme rexa)2 Deputy Medical Examiner GRADE Grade r CDR INSTALLATION OR ADDRESS Installation ou adresse Dover AFB, DE 1990• DA..T...E... .D..—ate. (-)aq 13)(0-2 I State disease; injury-or complication Mt 2 State conditions contributing to the des h, but not related lo the disease or condition causing death. ,1.. P rociser la nature de Id MaMdie,:de la Measure ou dela complication qui a contribuo ata-mort, milli non ia Maniere, de mourir, lege qu 'tin (met du coeur, etc Prbaber la condition qui a'Contribuo- Ella mort, mail reayant autun rapport avec la maladie oua 49 condition qui a: provoqud tamort. _, DD1AOPRR M7 7 2064 REPLACES DA FORM 3565, I JAN 72 AND DA FORM 3565-R(PAS), 26 SEP 75. WHICH ARE OBSOLETE. MEDCOM - 175 DOD 003302 CERTIFICATE OF DEATH (OVERSEAS) Acte de deces (D'Outre-Mer) e zeeuc n n , •fr, u decode (Nom et prenoms) GRADE Grade BRANCH OF SERVICE Arme SOCIAL SECURITY NUMBER Nurnero de l'ASsurance Sociale 1:.)(13)-4 I ORGANIZATION Organisation NATION (e.g., United States) Pays Iraq DATE OF BIRTH Date de naissance 01 Jan 1929 SEX Sexe El MALE Masculin q FEMALE Ferninin RACE Race MARITAL STATUS Etat Civil RELIGION Culte X CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce PROTESTANT Protestant OTHER Autre (Spe (Specify) cifier) NEGROID Negriode MARRIED Marie CATHOLIC SEPARATED OTHER (Specify) Separe Autre (Specifier) WIDOWED Veuf JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decede avec le susdit STREET ADDRESS Domicile a (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Vile (Code postal compris) MEDICAL STATEMENT Declaration medicale CAUSE OF DEATH (Enter oNy once cause per line) Cause du dents (N'indiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH Intervene enve I'attaque et le daces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH/ Maladieou condition directement responsable de la more Severe atherosclerotic cardiovascular disease Minutes ANTECEDENT CAUSES SymptEmes precurseurs de la mort. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, s'il y a lieu. menant a la cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, eil y a lieu. ayant suscite la cause primaire 'OTHER SIGNIFICANT CONDITJONS 2 Autres conditions. SignifiCativee MODE OF DEATH Condition.de aces AUTOPSY PERFORMED Aulopsie effectuee DYES Oui nNO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES MAJOR, FINDINGS OF AUTOPSY Conclusions principales de l'autopsie Circonstances de la mor/ suscitees par des causes exterieures X NATURAL Mort nalurelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du pathologIste loxsy2 ICDR, MC, USN HOMICIDE Homicide bl(422 .DATE Date . 18 May 2004 AVIATION:ACCIDENT Accident a Avion • YES Oui NO Non - DATE OF DEATH ( Date de daces (I'heure, 11 May 2004 le , b)(6)-2 jo • • •• • Baghda DEATH Lieu de pieces • , Iraq I.HAVE VIEWED THE REMAINS-OF THE DECEASED AND DEATH OCCURREDAT THE TIME:INDICATED AND'FROM THE CAUSES AS STATED' ABOVE. J'aiexamine lesrestes mortals du de funtet ie conclus qua le daces est survenval'heure indiquee et 6, la suite des causes enumerees o-dessus. NAME OF MEDICAL OFFICER. Nom du medlcin.militaire ou du.m4Klicin sanitaire TITLE OR DEGREE Titre ovdiplerne Deputy Medical. Examiner b)(13}2 :GRADE Grade INSTALLATION OR ADDRESS Installation:au adresse 'CDR. Dover AFB, DE 19902 DATE Date 04 13)(8)-2 , cl<,....) Wnil_ . 1 State disease, injury,or complication . 2 State conditions contributing to the dea 1 Preciser la nature de to maladie, de la 2 Preciser la condition qui a contribue A la etc. non la maniere de Murk. tee qu 'un antt du coeur, etc qui aprovoque la moa h, but not related to the disease or condition cawing death: blessute ou de la complication qui a confribuo Ala molt, mais molt, mais ifayant aucun rapport-avec la maladie opals condition DD511,2064 REPLACES DA FORM 3565, 1 JAN 72 AND DA FORM 3565•R(PAS).26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 176 DOD 003303 - ' ' ' CERTIFICAT.E.OF DEATH (OVERSEAS) • Acte deeps (f/burro-Mei) GRADE -Grade BRANCH OF SERVICE Arnie SOCIAL SECURITY NUMBER Numero de 'Assurance Sociale flPCPAS Pfl II et Pirt Nom du decede(Nom et prenoms) ORGANIZATION Organisation Detainee in Iraq ' NATION (e.g.. Unged States) Pays USA DATE OF BIRTH Date de naissance SEX Sexe EI MALE Masculln FEMALE Ferninin RACE Race MARITAL STATUS Etat Civil RELIGION Culle X CAUCASOID Caucasique SINGLE Celibateire DIVORCED Divorce PROTESTANT Protestant , OTHER (Specify) Autre (Specitier) NEGROID Negriode MARRIED ..Marie CATHOLIC Calholique SEPARATED OTHER (Specify) 'Separe Autre (Specifier) WIDOWED Veuf JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du deckle avec le susdit STREET ADDRESS Domicile A (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration medicate . . ... .. CAUSE OF DEATH (Enter only once cause per line) Cause du deals (N'indiquer qu'une cause par Ilgne) INTERVAL BETWEEN ONSET AND DEATH Inlervalle entre rattaque clue deals I DISEASE OR CONDITION DIRECTLY LEADING TO DEATH / Maladie ou condition directement responsable de la mort. Blunt force injuries complicated by compromised • respiration ANTECEDENT CAUSES Sympbbmes precurseurs de la mod. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, ea y e Mau. menant Ala cause primaire UNDERLYING CAUSE, IF ANY, avant suscitb to cause primaire GIVING RISE TO PRIMARY CAUSE Ralson fondamentale, s'il y a lieu, • OTHER SIGNIFICANT CONDITIONS 2 Autres conditions significatives` , • MODE OF DEATH Condition de deces AUTOPSY PERFORMED Aulopsie effectuee RIYES Out fl NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mod suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Conclusions principales de I'autopsie NATURAL Mort nalurelle ACCIDENT Mort accidentelle SUICIDE Suicide j( j'. " '''''-ir Nom du pathologists I f'Ir117 ruin I ICK1 b)(6)-2 x HOMICIDE Homickle DATE Date 09 Nov 2003 AVIATION ACCIDENT Accident A Avion • YES Oui r, NO Non , DATE OF DEATH (Hour cl Da e de deas (rheum, C) 04 Nov 2003 b)(8)-2 - lee) PLACE OF DEATH LieU de dikes - • . Baghdad, Iraq _ I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'al examine les restes morlets du de funtet je conclus quo le deces eat sUivehu A rheure indiquee et A, la suite des causes lanurnerees cl-dessus. NAME OF MEDICAL OFFICER Nom du rnedicin mililaire Cu du medlcin sanitaire TITLE OR DEGREE Titre ou dipleme Deputy Medical Examiner rin-2 GRADE Grade CDR INSTALLATION OR ADDRESS Installation ou adresse DoverkFB, DE 19902 DATE Date 13 p,A -1,100Y SIGNP bile)- I State disease, injury or complication which caused 2 State conditions contributing fb the death, but not it I Preciser la nature de la meted* data blessure ou de laWmplicetion qui a contribud A' la mod. Mats non Is maniere de mourir, tells qu 'tin erre( du coeur, etc 2 Preciaer Is condition qui a contribue A Is rnort, mais nays nit aucun rapport avec la maledie ou a la condition qui a prorogue Is mort. - - - tF24141.7 REPLACES DA FORM 350, I JAN 72 AND DA FORM 3565-R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 177 DOD 003304 CERTIFICATE O DEATH (OVERSEAS) Acte cte ci.Oes (IX014ire-4.1W) NAME OF DECEASED (Last, First, Middle) Nom du &Medi) (Nom et prenoma) GRADE Grade BRANCH OF SERVICE Anne SOCIAL SECURITY NUMBER Plumero de 'Assurance Sodele b)(8)..4 bXe)-4 I ORGANIZATION Organisation Detainee in Iraq NATION (e.g., United States) PaYO Iraq DATE OF BIRTH Date de naIseance SEX Saxe - RI MALE Masculin FEMALE FenliIIII) RACE Race _ . . MARITAL STATUS etat Civil RELIGION Cul e X CAUCASOID Caucasique SINGLE CLIillbaleire :ACED Divorce DIVORCED PROTESTANT Protestant (Specify) Autre (Specifier) NEGROID Negriode _ . . MARRIED Marie CATHOLIC Catholique SEPARATED Sepere • OTHER (Specify) Autre (Specifier) - WIDOWED Veut JEWISH JO. NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du deckle avec le susdIt STREET ADDRESS Domicile a (Rue) CITY OR TOWN AND STATE (Incliide ZIP Code) VIM (Code postal compris) MEDICAL STATEMENT Declaration medicare CAUSE OF DEATH (Enter only once cause per 10 Cause du dimes (Prindiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH Inlervalle antra l'attaque et le daces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Melodie ou condition directement responsable de la mod! .1 Asphyxia due to smothering and chest compression _ ANTECEDENT CAUSES SymptOmes precurseurs do la mod. MORBID CONDITION. IF ANY, LEADING TO PRIMARY CAUSE Condition morbide. s'il pa lieu. monad a la cause primate UNDERLYING CAUSE, IF ANY. GIVING RISE TO PRIMARY CAUBE Raison fondarnentale. s'il y a lieu. ayant suscite la cause primeire OTHER SIGNIFICANT CONDIIIONS 2 Autres conditions significative? _ MODE OF DEATH Condition de dikes AUTOPSY PERFORMED - Autopsie effecitiee RIYES Dui fl NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO - EXTERNAL CAUSES Ciroonstande.s de la most suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Conclusions princlpales de rautopsie NATURAL Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du palhologiste b)(8)-1 I MA .1 Mr. 11RA b)(8)-2 x HOMICIDE HurnIcide DATE Dale 02 Dec 2003 AVIATION ACCIDENT Accident i Avian • YES Out Mt NO Non DATE OF DEATH (Hour De e de daces (l'heure, a 26 Nov 2003 y„ year; jour, le mois, l'annee) PLACE OF DEATH Lieu de deces - Al Qaim, Iraq I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. ..Fei examine les testes mortals du d6 funtet Jo conchs qua le daces not survenu a Metre inclIqUee et A, le suite des causes enumerates ci-clessus. NAME OF MEDICAL OFFICER e)(5)-2 Nom du Median Militalre ou du merlicin sanitaire TITLE OR DEGREE Titre ou dipli5Me Deputy Medical Examiner GRADE Grade MAJ INSTALLATION OR ADDRESS Install3tion ou adresse . . Dover AFB, DE 19902 DATE Date /2. P'7 2051{ b)(13)-2 1 State disease, injury or complication which c 2 State Conditions contributing to the death. il . ' Preciser la nature de la male die. de /3 !Measure du dole complication qui a contribue a la Zrt. male non la manure de mourir, toile qu 'un arrlt du coeur, etc 2 Precker M condition qui a COntribuo e iamori, male n'ayarif aucun. rapport avec la maladie o u ala condition quip pro acquit Is mod. • 1 APR 7? REPLACES DA FORM 3565, 1 JAN 72 AND DA FORM 3565-R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 178 DOD 003305 CERTIFICATE OF DEATH (OVERSEAS) Acte.cle 'Mae (D'Outre-Mer) ' NAME OF DECEASED (Last First, Middle) Nom du decode (Nom et.prenoms) GRADE Grade .BRANCH OF SERVICE Arnie SOCIAL SECURITY NUMBER Numero de l'Assarance Sociale :6)(6)-4 Detainee in Iraq ORGANIZATION Organisation NATION ;(e.g.,United States) , Pays Iraq L DATE-OF BIRTH Date de naissance SEX - Sexe IZI •MALE Mascuin FEMALE ' Feininin RACE Race MARITAL STATUS Etat Civil RELIGION Culte X CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce :PROTESTANT .Protestant OTHER (Specify) Autre . (Specifier) ; NEGROID Negriode MARRIED Marie CATHOUC , Catholique , SEPARATED &Spare OTHER (Specify) Autre (Specifier) WIDOWED Veuf JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec In susdit STREET ADDRESS Domicile a (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration meclIcale CAUSE OF DEATH (Enter only once cause per line) Cause du cakes (N'indiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH Intervalle'entre I'attaque et le dock r DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable de la more Closed Head Injury with a Cortical Brain Contusion and Subdural Hematoma ANTECEDENT CAUSES SymptOmes precurseurs de la mom. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition carbide, sit y a lieu. menant a la cause primaire CAUSE Raison tondamentale, s'il y a lieu, ayant susche la cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY . 'OTHER SIGNIFICANT CONDITJONS 2 ;Autres conditions signilicativee • MODE OF DEATH Condition de dears AUTOPSY PERFORMED Autopsie effec wars RYES Oui nNO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mon suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Conclusions principales de l'autopsie : NATURAL Mort naturelle . . ; ACCIDENT ; Mortaccidentelle !SUICIDE Suicide 'NAME OF PATHOLOGIST Nom.du pathotogiste 5)(61-2 LtCol, MC, USAF x 'HOMICIDE Homicide .SIGNATURE_Sfanatisse- . DATE Date 17 Jun 2003, OCR AVIATION ACCIDENT Accident a Avian • YES Oui [21 NO Non ;DATE OF DEATH. (Hour day, month, ;Da e de deals (l'heure, a-jaw, le mois, l'annee) 13 Jun 2003 n ...,,,,,n- La_ATH lieu de dices 'Iraq • I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH-OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine-les testes mortals du de luntetie conclus que.le decits.est survenu a rheure indiquee et a, la suite des causes enumerees ci-dessus. :NAME OF MEDICAL OFFICER. Nom du medicin militaire ou Mu medicin.sanitaire :TITLE OR DEGREE Titre ou diplOme :b)(6)-2 'First.Chief Deputy Medical Examiner GRADE Grade LtCol INSTALLATION OR ADDRESS Installation ou adresse- Dover AFB, DE 1:9902 ;DATE Date )Ly .."-.7 C7 1/ :SIGNATU F Sinnatilra b)(6)-2 but not mode of dying such as heart to the disease or condition causing complication qui a contribue d la.mort, aucun rapport avec la maladie i I State disease, injury or -complication which caused death, Z State conditions contributing to the death, but not related 1 Prdciser la nature dole maladie, dole blessure -ou _de la 2 Preciser la condition qui-a contribue d la mort, mais n'ayant failure. etc. death. mais non la maniere de mourir, telle qu lun arra: du coeur, etc otta la condition qui a provoque Is mart. 1 APR 77 , . C. MEDCOM - 179 DOD 003306 CERTIFICATE OR DEATH (OVERSEAS) APta'de dedeble'O:itieriMeir) NAME OF DECEASED (Last. First Middle) Norn .du•dateda (Nom et 'prenorna) GRADE Grade BRANCH OF SERVICE Arrtie SOCIAL SECURITY NUMBER kumero do Assurance Satiate - ;ORGANIZATION Organisation Detainee in Iraq NATION - (6:9., United States) Pays Iraq ; DATE OF BIRTH Dale de naissance .07 Jan 1957 SEX'. Sexe : El MALE Masculin FEMALE Feminin RACE Race . . Etat Civil RELIGION . Culte _ .2C _ r . CAUCASOID Caucasique SINGLE Celibateire , DIVORCED Divorce' PROTESTANT Prot eslant OTHER ' (Specily) Autre- (Specifier) ! NEGROID NegrMde ;MARRIED Marie CATHOLIC Cathollque SEPARATED OTHER(Specify) Sept* Aulre (Specifier) WIDOWED ' Veul JEWISH Jun NAME OF NEXT OF KIN Nom du plus proche parent :RELATIONSHIP TO DECEASED Parente du decede-avec le susdit STREET ADDRESS Domicile a (Rue) :CITY OR TOWN AND STATE (Include ZIP Code) yule postal coMpris) MEDICAL STATEMENT D4Ciaration'medicale CAUSE OF DEATH (Enter only once cause per line) Cause du dikes (N'indiquer qu'Une cause par ligne) INTERVAL BETWEEN - ONSET AND DEATH Intervene entre , rattaque;e1 le decks / DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladle ou condition directernent responsable de le mort l. Blunt Force Injuries and Asphyxia ANTECEDENT CAUSES Symplames precurseUrs de la mod. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, all y a lieu. menent a la cause primaire UNDERLYING CAUSE,JF ANY. GIVING RISE TO PRIMARY CAUSE Raison fondamentale. s9l y a lieu. ayant suscile la cause Orimaire - OTHER SIGNIFICANT CONDITIONS 2 Autres Conditions 51(fniticatiyes2 MODE OF DEATH Condition ckEdeces AUTOPSY PERFORMED Autopsie effectuee 1711YES Oui flNO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES ClOconstances de la mort suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Conclusions prIncIpales de l'autopsie NATURAL Mod nalurelle ACCIDENT Mort accIdenIelle SUICIDE Suicide NAME OF PATHOLOGIST NOm du palhologiste bX6)-2 co)* MC, USN • x HOMICIDE Homicide SIGNA b)(6)-2 IDATE Date 11 Jan 2004 AVIATION ACCIDENT Accideni A Avion • YES r4 NO Non DATE OF DEATH (Hour day. fl Da e de decks ("haute, le i'06,-, i(nX6)-2 09 Jan 2004 I PLACE OF DEATH Lieu e deices Al Asad, Iraq I HAVE VIEI.LLI I lib REMAINS THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les testes mortels du de runlet je conclus qUe le del:6,0st survenu A I'heure Indiquee et a. Is suite des causes enumerees en dessus. NAMF AF'mFnirro OFFICIFR Nom du medicin rialltaire Cu du medical sanitaire TITLE OR DEGREE Tete ou diploma Chief Deputy Medical Examiner b)(6)-2 GRADE Grade CDR INSTALLATION OR ADDRESS Installation ou adresse Dover AIB, DE 19902 ,. DATE Date 1 ;3 MAY,)-CO LI SIGNA "6)-2 . 1 State disease, injury or coinplicetion .whicheituied ' F State conditions contributing to the death, but not re 1 Prectserle nature dale male die, de la, blessure Cu dole complication qui a contnbue d ie nilit mans non le manidre de mouth', belle qu Mn an-el du coeur, etc 2.Preerser le condition gig a contribue die Moil, mats ieeyeiit aucun rapport 81iliC /a ininedio ou a la condition qui a prtivoque M inorl. — — — — — - . 1F,811% REPLACES DA FORM 3565, I JAN 72 AND DA FORM 35654R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 180 DOD 003307 .CERTIFICATE.OF, EATI-I (OVERSEAS) Acte d deces (=PITO-Mar) NAM n F EAS 0 La t om du decade (Nom et arenoms) GRADE Grade BRANCH OF SERVICE Anne SOCIAL SECURITY NUMBER Numero de ('Assurance Societe 12)101-4 ORGANIZATION Organieadon Detainee in Iraq NATION f e.g., United States) Pays Iraq DATE OF BIRTH Date de naissance SEX Sexe E I MALE Masculin FEMALE Foonin RACE Race MARITAL STATUS Etat Civil __. • RELIGION Culte X CAUCASOID Oaucasique SINGLE Celibataire DIVORCED Divorce PROTESTANT protestant OTHER (Specify) Alltre (Specifier) NEGROID Negriode MARRIED Marie CATHOLIC Catholique SEPARATED 46Pqre OTHER (Specify) Aulre (Specifier) WIDOWED Veul JEWISH JO NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parents du decade avec la susdil STREET ADDRESS Domicile A (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration medicate CAUSE OF DEATH (Enter only once cause per line) Cause du daces (N'indiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH Inlervalle entre renegue et le daces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable de la mortl. Heat related ANTECEDENT CAUSES SYmPleMes precurseurs de la no. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, 511 y a lieu. menant Ala cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'ii y a lieu, ayant suscite la cause prirnaire OTHER SIGNIFICANT CONDITIONS 2 Autres conditions significatives` MODE OF DEATH Condition de decals AUTOPSY PERFORMED Autopsie effeCtuee YES Oui f NO Non CIRCUMSTANCES SURROUNDING DEATH. DUE TO EXTERNAL CAUSES Circonstances de la mort suscitees par des causes exlerieures MAJOR FINDINGS OF AUTOPSY Conclusions prInCipales de l'autopsie NATURAL Mort naturelle x ACCIDENT Mort accldentelle SUICIDE Suicide NAME OF PATHOLOGIST Non, du pathologiste )(6)-2 MAJ, MC, USA_ HOMICIDE Homicide b)(6)-2 . )(13)-2 DATE Date — 23 Oct 2003 AVIATION ACCIDENT Accident a Avian. • YES Oui ra NO Non Date de dikes (rheum e 2...2. Au.. g .22. 00003 DATE OF DEATH (Hour ..y. .......—. ,—, four, le mots. Peones) laUNI:t (JI- titAt 11 Lieu de dikes Iraq . I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. Jai examine les reales mortals du de runlet je conclus qua le thices est survenu A l'heure indiquee et a, la suite des causes enumerees c:-dessus. NAME OF MF1110A1 OFFir.FR 13)(0)-2 ' Nom ou rThigjicin militaire ou du medicin sanitaire TITLE OR DEGREE Titre ou Olen* Deputy Medical Examiner GRADE Grade A AJ [NATALIA:NON OR ADDRESS Installation ou adresse Dover AFB. DE 19902,7 --)(ey2 . Date TV454 I State disease, injury or complication which Qmsecroa.a., ,re, normornraroying-suarras-neernesure, etc. 2 State conditions contributing to the death, but not related to the disease or condition, cawing death. 1 Prdciser /a nature de la maladie. de la blessure ou de /a complication qui a contribue 6 le mort, male non la maniere de moult toile qu 'tin arret du occur, etc 2 Pradser la condition qui a contribu6.4 la molt, mals n'ayant aucun, rapport avec la maladies ou A la. condition qui a provoque la Mort. 1 APR 77 REPLACES DA FORM 3565, 1 JAN 72 AND DA FORM 3565-R(7AS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 181 DOD 003308 . . „ CERTIFICATE OF DEATH (OVERSEAS) • • . Acte de. dikes (iYaiitie-med - NAME OF DECEASED (Last. First. Middle) N m du decode (Nom et prenoms) GRADE Grade BRANCH OF SERVICE Arnie Iraqi Civilian SOCIAL SECURITY NUMBER Nuttier° de ('Assurance SeijialO X )-4 ,ORGANIZATION Organisation Detainee in Iraq NATION (e.g., United States) Pays Iraq DATE OF BIRTH Date de naissance SEX Sexe 0 MALE I.nI bieHUin FEMALE Ferninin RACE Race - - - - MARITAL•STATIjS Etat Civil RELIGION _ CUlle X . CAUCASOID Caucasique • • SINGLE Celibetaire DIVORCED bivorce PROTESTANT Protestant . .. OTHER (Specify) Autre (Specifier) NEGROID Negriode . ;__• • MARRIED Marie CATHOLIC Catholique SEPARATED Separe . • • OTHER (Specify) Autra(Spectifier) , „ WIDOWED Veuf JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent • RELATIONSHIP TO DECEASED Parente du decode avec le susdil STREET ADDRESS Domicile a (Rue) • • CITY OR TOWN AND STATE (Include ZIP Code) Ville (Ocide postal cortiodS) MEDICAL STATEMENT -Declaration-medicate CAUSE OF DEATH lEnteronlY once cause per him) Cause du dices (N'indiquer qu'une cause par ligne) INTERVAL sErWEE:H Intervalle entre. ONPELAND.4EATH Yattaque.et le decies. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable de la mon! Atherosclerotic Cardiovascular Disease i ANTECEDENT CAUSES s'yrremomes precurseurs de la mart. MORBID CONDITION,: IF: LEADING. TO PRIMARY CAUSE Condition morbide, s'it ya lieu. mertantala cause primaire UNDERLYING CAUSE, IF ANY. GIVING RISE TO PRIMARY •CAUSE • - Raison fondarnentale, VI y a lieu, ayant suscite Is cause primaire . . . „ OTHER SIGNIFICANT CONDITIONS 2 Aulres conditions significatives` MODE OF DEATH Condition de dimes AUTOPSY PERFORMED Autopsie effeetuee - RYES Dui n NO Non 'CIRCUMSTANCES SURROUNDING DEATH DUE TO .EXTERNAL CAUSES Circonstances de la mod suscitees par des causes exlerieures AVIATION ACCIDENT Accident A Avion ¨ YES Dui • IRI No. Non MAJOR FINDINGS OF AUTOPSY Condusions prindpales de rautoPsle - X -' NATURAL Mort nettirelle - i ... . •ACCIDENT Mort. accidentege .SUICIDE Suicide . . . ,HOMICIOE : Homicide NAME OF PATHOLOGIST Nom du pathologisle USA • •X6 )-2 . MAJ, MC, b)(6)-2 DATE Date .28 Feb-2004 •DATE OF DEATH-(Hour --....r. no.luh. yowl.. Date de dikes (I'heure, le jour, le mos, fanners) 08 Feb 2004 - - . . . PLACEOF DEAL H Lieu de deces Tikrit, Iraq I HAVE VIEWED THE REMAINS OF THE DECEASED AND,DEATH OCCURRED AT THE TIME'INDICATED AND.FROM THE CAUSES AS STATED ABOVE. . lid examine lee restos mortels dude luntet )e.concius que le decits out survenu a rheure indiquee et a. la suite des causes enurnerees ci-dessys. NAME OF MEDICAL OFFICER Nom du medicin militaire ou du rnedicin sanitaire TITLE OR DEGREE Titre ou diplerne 13)(0,-2 Deputy Medical -Examiner GRADE Grade MAJ INSTALLATION OR ADDRESS Installation ou adresse Dover AFB, 'DE 19902 DATE Dale . • .11 -'14 .11 tr. C)Lf ,bX 13)-2 1 State disease, injury or complication which caused death, but not mode of dying such as heart failure, etc. :2. state conditionecontrihuting to the death, but not related to the disease or condition causing death., . . . •I • Precise, la.nature•da la maladie, de la bless,ureou de te complication qui a contribud d la mora, !Pala non /a mentors de.reourt Celle qu 'un ant( du coeur, etc 2 Preclser Is condition qui a contribee a le mod, mals n'ayant .aucun rapport avec la maladie ou a 1a condition qul a prorogue la mort. IMP •Ik ' In.ra. . #1,01k A A ---- 1 APR 77 ,1 JAN72 AND DA FORM 3565-R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 182 DOD 003309 - . ' .. CERTIFICATE OF.DEATH (OVERSEAS) ' Acte de . d. a ces (D'Outi-44 er) NAME C1F -nR-FARFn a act gi t ukotim am,. MI d6 ade (Nom at prenoms) . GRADE Grade BRANCH OF SERVICE Arrne ' Iraq Civilian SOCIAL SECURITY NUMBER' ' NUrner0 de l'AssArenCe Sodale )(6)-4 ti ORGANIZATION Organisation Detainee in Iraq NATION • (e.g. United States) Pays ' Iraq DATE OF BIRTH Dale de nais.sanee 01 Jan 1950 SEX Sexe ' IZE MALE Masculin FEMALE Feminin RACE Race MARITAL STATUS Etat Civil ' RELIGION Culti . X . CAUCASOID Caucasleue SINGLE Celibataire DIVORCED DiVorCe CATHOLIC PROTESTANT PMtestani OTHER (Specify) Autre (Specifier) NEGROID Negrlocie MARRIED Marie Catholique SEPARATED &Spare .. OTHER (Specify) Autie'(Specifier) • WIDOWED Veuf JEWISH Juil NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec le susdit STREET ADDRESS Domicile A (Rue) CITY•OR TOWN AND STATE (Include ZIP Code) Villa (Code postal commis) MEDICAL STATEMENT Declaration medicate CAUSE OF DEATH (Enter only once cause per line) Cause du deices (N'indiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH' Inlervalle entre • . rattaque of Ia daces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH f Maladle ou condition directement reSponsable de la mod! Acute •Peritonitis secondary to Perforating Gastric Ulcer - ANTECEDENT .1 CAUSES Symptemes preeurseurs de la 111011. MORBID CONDITION. IF ANY. LEADING TO PRIMARY CAUSE Condition inorbide, sll y a lieu. menant A la cause prlmaire . . ... .. UNDERLYING CAUSE, IF ANY. GIVING RISE TO PRIMARY • CAUSE Ralson fondamentale. s'il y a lieu, ayant suscite la cause prirnaire OTHER SIGNIFICANT CONDITIONS 2, Autres conditions signiliCatives` MODE OF DEATH Condition OS dikes AUTOPSY PERFORMED Autopsie effectuee RYES Oul • nNo Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la inert suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Condusions principales de rautopsie • NATURAL Mort naturelle ACCIDENT Mod accicientelle SUICIDE • Suicide NAME OF PATHOLOGIST • Nom du pathoiogiste Xe)-2 1 MAJ, MC, USA HO. MICID. E , H. omicide ( (13)(13)-2 DATE • Dale 28 Feb 2004 AVIATION ACCIDENT Accident if Avion • YES Oui IJ NO Non, DATE OF DEATH (Hou , say, i u um year) ' Dale de deces (Pheure, le jour,le ',lois, ranee) 19 Feb 2004 PLACE OF DEATH Lieu de deces • Abu Ghraib Prison, Iraq • I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. lei examine les testes models du de funtet jet condus qua le deeds est survenu'A'rheure indlquee et A, la suite des causes enumerees cl-dessus. •NAME OF MEDICAL OFFICER Nom du medicin militaire ou du mddicln sanitaire • TITLE OR DEGREE Titre ou dipleme Deputy Medical Examiner GRADE Grade • •EMAJ INSTALLATION OR ADDRESS Installation ou adresse - Dover AFB, DE 19902 j DATE Dale 1 ►tA. 641 Le Lk.(- Xe)-2 1 State disease. injury or complication which caused death, but not mode of dying such as heart failure, etc. 2 State conditions contriAlitIng be the death, bu not related fo the disease or 'condition PaUsingdoith. 1 ,PrAciser la nature de la maladie.de la blessure ou de la complication Ole 'crintribire' Ara mat, mais non to manlike de moudr, tells qu 'un err& du coeur, etc •2 Pre'ciaer la condition qui a contribue A la mod, trials n'ayaPt aucun rapped 'avec la maladie ou Ala condition qui a pnevoque Ia Mort. 1 APR 77 , I JAN 72 AND DA FORM 3565-R(PAS). 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 183 DOD 003310 CERTIFICATE OF DEATH (OVERSEAS) Acte de d+cOs (DVOre-Mar) NAMF GF GFrFARFD rr so Fuel Adieltilal run., du dricede (Nom at prenoms) GRADE Grade BRANCH OF SERVICE Arrne SOCIAL S ECURITY NUMBER Nurnero de l'Assurance Sociale ORGANIZATION Organisation Detainee in Iraq NATION (e.g., United States) Pays Iraq DATE OF BIRTH Date de naissance 06 Dec 1948 RACE Race SEX Seize IR1 MALE Mescuiin El FEMALE Ferninin MARITAL STATUS Etat Civil RELIGION Cults X CAUCASOID Caucasique NEGROID Negriode SINGLE C..elibataire MARRIED Marie WIDOWED Veal DIVORCED Divorce SEPARATED Ware PROTESTANT protestant CATHOLIC Catholique JEWISH Juit OTHER (Specify) Autre (Specifier) RELATIONSHIP TO DECEASED Parente du decade avec le susclil CITY OR TOWN AND STATE (include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration medicale . _ INTERVAL BETWEEN ONSET AND DEATH Inlervalle erttre l'atiaque at le dikes Atherosclerotic Cardiovascular Disease CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonslances de la mort suscitees par des causes exterieures fitologisle MC, USN use MYES Oul usions principales de PaUtopsie TH (Enter only once cause per line) (N'indiquer qu'une cause par ligne) DATE Date 10 Mar 2004 AVIATION ACCIDENT Accident a Avian YES Dui NO Non PLACE OF DEATH Lieu de deces Baghdad, Iraq EASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. tel je conclus qua le daces est survenu a l'heure indiquee et a. la suite des causes enumerees c:-dessus. sanitalre TITLE OR DEGREE Titre ou diplarne Chief Deputy Medical Examiner ADDRESS Installation ou adresse AFR nF 199n9„, DATE Date ... 1 3 in A if 4- 0 0"1 I State disease, injury or complication which caused 2 State conditions contributing to the death, but not it I Prociser la nature dole maladie, de Ia blessure ou fella qu 'un &ref du coeur. etc 2 Preciser la condition qui a contrtue C Ia mort, mals Wayanaucun rapport avec la maladie ou ala condition qui a provoque la mort. DD FORM ,A,R772064 REPLACES DA FORM 3565,1 JAN 72 AND DA FORM 3565-R(PAS), 16 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 184 DOD 003311 SIGNA CERTIFICATE OF DEATH (OVERSEAS) Acte de deeds (D'Outre-Mer) ,-,,1,, NAME OF DECEASED (Last, First, Middle) Nom du diced, (Nom et prenoms) GRADE Grade BRANCH OF SERVICE Alma SOCIAL SECURITY NUMBER Numero de ('Assurance Sociale ,,,,b)(8)4 I. ORGANIZATION Organisation Detainee in Iraq NATION (e.g., United States) Pays I raq DATE OF BIRTH Date de naissance SEX Sees 2 MALE Masculin FEMALE Feminin RACE Race MARITAL STATUS Etat Civil RELIGION Culte X CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce PROTESTANT Protestant OTHER (Specify) Autre (Specified NEGROID Negriode MARRIED. Marie, CATHOLIC Catholique SEPARATED Ware OTHER (Specify) &lire (Specifier) 'WIDOWED Veuf JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du &cede avec le susdit STREET ADDRESS Domicile A (Rue) CITY OR. TOWN.AND STATE (include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration medlcale CAUSE OF DEATH (Enter only, once cause per line) Cause, du deces (N'indiquer qu:une cause par ligne), INTERVAL BETWEEN, ONSET AND,DEATH Intervalleentre renegue etle dimes DISEASE OR CONDITION DIRECTLY LEADING TO. DEATH ,Maladie ou condition directement responsable de la.mort i. Massive hemoptysis due to tuberculosis ANTECEDENT CAUSES Symptornes precurseurs de le mon. MORBID CONDITION, IF ANY, LEADING.TO,PRIMARY CAUSE Condition morbide,s1t, y, a lieu. menant A la cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'il y, a lieu, ayant anal, Ia cause primaire OTHER, SIGNIFICANT CONDITJONS 2 Autres Conditions significativee MODE OF DEATH Condition de daces AUTOPSY PERFORMED Autopsie effectuee YES Oui nNO Non CIRCUMSTANCESSURROUNDING DEATH.DUE TO . EXTERNAL CAUSES Circonstances de le mortsuscitees. par des causes exlerieures MAJOR FINDINGS OF AUTOPSY Conclusions principalis de l'autop,sie x NATURAL Mort naturelle ACCIDENT Mon accidentelle •SUICIDE Suicide NAME OF PATHOLOGIST Nom b)(6)-2 du pathologiste CAPT, Mc, USN HOMICIDE Homicide b(bxe).2 DATE Date 13 Jul 2003 AVIATIONACCIDENT. Accidents Avion • YES Oui NO Non DATE OF DEATH (Hour PLACE OF DEATH Lieu de decas Iraq :Date de .daces Obeys, e our, to mors, ranee) 12-Jul• 2003 I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les testes morcels du de (unlet le conclus que le aces est suryenu A l'heure indigoes et A, la suite des causes onumerees ci-deSSUS. 'NAME OF MEDICAL OFFICER Nom du rnedicin militaire ou du rnedicin sanitaire TITLE OR DEGREE Titre ou diplOme Armed Forces Medical'Examiner ;b)(6)-2 .GRADE Grade •-•CDR INSTALLATION OR ADDRESS Installation ou ad ,esse Dover AFB, DE 19902 bX6)-2 b)(6)-2 . "'I! Ad a$ ..tal — DATE Date j 4/1141tNit 0 q , ,'. I State disease, injury or, complication ,which =art failure, etc. '.2 'State conditions contnbuting fo the death, bu not related to the disease or condition causing death. I Precis& to nature de to maladie, de Is Nessure ou.de Ia complication qui a contribue 4 Ia mon, mais non la maniere de mount, tellequ 'un art& du coeur, etc 2 Proeiser la condition qui a coneibud 4 la mod; mais Wayant aucun rapport avec la maladie or' 61a condition qui a provoque la mod. 1 ApR 717: , 1 JAN72 AND DA FORM 3165•1(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 185 DOD 003312 CERTIFICATEDEDEATH {OVERSEAS) Acta &Aeolis (D'Outre-Med GRADE Grade BRANCHOF SERVICE Arme SOCIAL SECURITY. NLIMBEFI .Numero de l'Assurance SOciale 6)±4 • • •ORGANIZATION • Organitation Detaineeiniraq -NATION. (eg.,,United Slates) Pays Iraq :DATE OF. BIRTH Date de naissance SEX Saxe Er MALE. Masculin , FEMALE . Feminin RACE Race MARITAL STATUS bat Civil RELIGION Culte ' CAUCASOID Caucasique SINGLE .Celibataire DIVORCED Divorce PROTESTANT Protestant OTHER (Specify) Autre (Specifier) NEGROID Negriode MARRIED Mull:, CATHOLIC Catholique SEPARATED OTHER (Specify) Silvan) `Autre (Specifier) WIDOWED . Veul ,JEWISH Juit NAME OF NEXT OF.KIN Nom du plusproche parent :RELATIONSHIP TO-DECEASED Parente du deckle avec le susdit STREET ADDRESS DorNcile a (Rue) •CITYOR TOWN AND STATE (Include ZIP Code) Me (Code pootal Conlpril) . ' MEDICAL STATEMENT . Declaration mei:Scale CAUSE OF DEATH (Enter only once cause per line) Cause du Maces (N'Indiquer qu'une cause par Ilgne) L ONSETINTERVA A BETWEEN ND, DEATH Intervalle entre l'atiaque et le daces / DISE4SE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable dela more. Undeterminded atraumatic.cause ANTECEDENT CAUSES Symptemes • precurseurs de la mort. MORBID CONDITION, IF ANY, LEADING TO PRIMARY. CAUSE , Condition morbide, MI y a lieu. monad Ala cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison-fondamentale, s'il y a lieu, ayant smite la cause primaire OTHER SIGNIFICANT CONDITIONS 2 ,Autres conditions significatives` MODE OF• DEATH Condition de daces AUTOPSY PERFORMED • Autopsie effectuee RYES „Cul riNo . Non CIRCUMSTANCES SURROUNDING DEATH DUE TO ' ' EXTERNAL CAUSES MAJOR FINDINGS OF AUTOPSY Conclusions princlpales de l'autopsie Circonstances de la most suscitees par des causes eiderieures x NATURAL ' Mort naturelle ACCIDENT ' Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du pathologiste ,b0)-2 COL, MC, USA HOMICIDE Homicide :b)(13)-2 . DATE Date 24 Aug 2003 AVIATION ACCIDENT Accident a Anion • YES Oui 4 NO Non DATE OF DEATH (Hour Date'cle dikes (rheum; 07. Aug 2003 PLACE OF DEATH. Lieu.de.deices Diwania, Iraq I HAVE VIEWED THE'REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les restes mortals do de funtet le conclus que le deals est survenu a l'heure indiquee et a, la suite des causes enumereas ci-dessus. b NAME OF MEDICAL OFFICER Nom du medicin militaire ou du rnedlcin sanitaire OR DEGREE Titre ou diplOme Armed Forces. Medical Examiner GRADE Grade INSTALLATION OR ADDRESS Installation ou adreTSSIT: CDR .Dover AFB, 19902 i' DATE Date AltiMA i Dt" .b)(8)-2 ( 61 ' ,c • 1.(2 .rill 1 State disease, injury or complication which m 2. State conditions contributing to the death, bu 1 PreCiser la nature de la maladic, de la bless, rlure, . eta th. tais non la maniere de mourir, tells qu 'up erre( du coeur, etc 2 Precise( la condition quia contribuo it lamort, mals n'ayant aucun rapport avec la maladie ou :a lit qui a provoque /a, mort DD 1 APR^77 REPLACES DA FORM 3565, 1 JAN 72 AND DA FORM 3565.R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 186 DOD 003313 CERTIFICATE OF DEATH (OVERSEAS) Acte de (feces (D'Outre4fer) NAME OF DECEASED (Last First Middle) Nnn du decade (Nom et prenomS) n GRADE Grade BRANCH OF SERVICE Arne SOCIAL SECURITY NUMBER Numero de !Assurance' Sociale ORGANIZATION Organisation Detainee in Iraq. NATION (e.g., United States) Pays Iraq. DATE OF BIRTH Date de naissance SEX Sexe IZI MALE Masculin. III FEMALE Feminin RACE Race MARITAL STATUS 8tat Civil RELIGION Culte X CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce PROTESTANT 'Protestant OTHER' (Specify) Autre (Specifier) NEGROID Negriode , MARRIED Marie CATHOLIC Catholique SEPARATED Separe OTHER (Specify) Autre (Specifier) WIDOWED Veuf ' JEWISH Juif NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente- du decade avec le susdit STREET ADDRESS Domicile A (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration medlcale CAUSE OF DEATH. (Enter only once cause per line) Cause du aces (NIndiquer quune cause par ligne) INTERVAL BETWEEN ONSET AND DEATH, Intervalle entre renegue - et le dines DISEASE OR CONDITION DIRECTLY LEADING TO DEATH/ Maladle ou condition directement responsible de N more Atherosclerotic cardiovasCular disease complicated by diabetes ANTECEDENT CAUSES Symptemes precurseurs de In mod. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, nil y a lieu. menant Ala cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'il y a lieu, ayant suscite la cause primaire OTHER SIGNIFICANT CONDITFINS 2 Autres conditions significativee MODE OF DEATH Condition de dimes AUTOPSY PERFORMED Autopsie effectuee OYES Out riN0 Non CIRCUMSTANCES SURROUNDING DEATH 'DUE TO EXTERNAL CAUSES Circonstances de Is mod suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Conclusions principales de l'autopsie . NATURAL Mort naturelle i ACCIDENT Mort, accidentelle ' SUICIDE Suicide .NAME OF PATHOLOGIST Nom du pathologiste (b)(6)-2 , COL, MC, USA HOMICIDE Homicide S b)(8)-2 DATE Date '24 Aug 2003 AVIATION ACCIDENT Accident a Avion IN YES Oui 4 NO Non ' DATE OF DEATH (Hour, dL-,---- PLACE OF DEATH Lieu de deces Abu Ghurayb. Prison, Iraq Da e de deeds (lbeunt.le four, le mois, Panne.) 08. Aug 2003 I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND-FROM THE CAUSES AS STATED ABOVE. Saiexamine les restes-mortels du de funtet je conclus qua le deces.est survenu a fheure indiquee et a, la suite des causes -enumerees ci-dessus: 'NAME OF MEDICAL OFFICER Nom du medicin militaire ou , du medicin sanitalre :TITLE OR DEGREE Titre ou dipleme Armed Forces Medical Examiner (b)(8)-2 GRADE Grade CDR INSTALLATIONOR ADDRESS Installation ou-ad ease Dover AFB.. DE 19902 bX8)-2 -.d/V "714 0-s" v Acirn, ies .,. State disease,. injury or complication which 2 State conditions contnbutingto therleath, 1 Prociser la nature de la maladie. dela blessure 2 Preciser la condition qui a contrIbue a la mort.mals — — — — - lailUre, etc. ut not related to the disease or condition causing aeath. ou de la complication qui a contribue a la mart, mail non la ,maniere de mourir, tele qu 'un arrot du coeur, etc n'ayantaucun rapport avec larnaladie ou ala-conditian qui aprovoquil la-mart 1%11117 REPLACES DA FORM,3565. I JAN 72 AND DA FORM, 3565-RIPAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 187 DOD 003314 CERTIFICATE OF DEATH (OVERSEAS) Acts de Oats (D'Outre-Mer) NAME OF DECEASED (Last First, Middle) Nom du decade (Nom et prenoms) GRADE Grade .BRANCH.OF SERVICE Arme ,SOCIAL SECURITY NUMBER; :Minter° de PAssuranceSociale b)(6)-4 ORGANIZATION Organisation Detainee in Iraq NATION (e.g.. United States) Pays Iraq DATE OF BIRTH 'Dale de naissance SEX Saxe lo MALE Masculin O FEMALE. Ferninin RACE Rate MARITAL STATUS EM Civil RELIGION Cube X CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce CATHOLIC PROTESTANT Protestant OTHER (Specify) Autre (Specifier) NEGROID Negriode MARRIED Marie .Calholique SEPARATED Separe OTHER (Specify) Autre (Specifier) WIDOWED Veuf JEWISH Jut NAME OF NEXT OF KIN Nan du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec le.sustlit STREET ADDRESS Domicile A (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compels) MEDICAL STATEMENT Declaration medicate CAUSE OF DEATH (Enter only once cause per line) Cause du deals, (N'indiquer qu'une cause par ligne) BETWEEN. ONSET AND DEATH, Intervale antra l'attaque et letteteS DISEASE OR CONDITION DIRECTLY LEADING TO DEATH / Maladie ou condition directement responsable de la morti. Arteriosclerotic cardiovascular disease ANTECEDENT CAUSES SymplOmes prtcurseurs de la mat MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition morbide, sll y a lieu. menant Ala cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondarnentate, sll y a lieu, ayant suscile la cause primaire OTHER SIGNIFICANT CONDIVONS 2 Autres conditions significatIves e MODE OF DEATH Condition de decks AUTOPSY PERFORMED Aulopsie effectuee RYES Oui n NO Non CIRCUMSTANCES SURROUNDING DEATH,DUE TO EXTERNAL CAUSES Clreonstances de la mora suscitees par des causes exterieures. MAJOR FINDINGS OF AUTOPSY Condusions principales de r autopsie x NATURAL Mort nalurelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du pathologiste ,b)(6)-2 MAJ, MC, USA HOMICIDE Homicide OX6)-2 DATE Dale 23 Aug 2003 AVIATION ACCIDENT Accidents. Axion • YES Oui ENO Non. DATE OF DEATH (Hour ,. „ Date de dices (rheum, e jour, le mais, 'armee) 11 Aug 2003 .." i. yr urA-rn—creo-ce deeds Abu Ghraib Prison, ,Iraq I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les restes models du de tuntet je condus que le deals est survenu A l'heure indiquee el A, la suite des causes enumerees ti-dessus. NAME OF MEDICAL OFFICER Nom du medicin militaire ou du medicin sanitaire TITLE OR DEGREE litre ou dlpleme !b)(6)-2 Deputy Medical Examiner GRADE Grade MAJ INSTALLATION OR ADDRESS Installation ou adresse Dover AFB. DE 19902 b)(8)-2 I DATE Date 24.y. 2 State disease,. injury or complicationwhich Slate conditions contributing to the death, but not related to the disease or condition causing death. 1 Piaciser la nature its la maladie, de la blessure ou de la complication qui a contribuo a la moil, mats non la maniere de mourir, tete qu 'un arret its coeur, etc 2 Recker la condition qui a contribue a la most mais n'ayant aucun rapport avec la melodic ou a la condition qui a provoque la moil, DA FORM 3565, I JAN 72 AND DA FORM 3565•R(PAS), 26 SEP 75, WHICH . ARE OBSOLETE. MEDCOM - 188 DOD 003315 OF DEATH (OVERSEAS) Acte de deals (D'Outre-Mer) t First, Middle) Nom du decade (Nom et prenom CERTIFICATE Fyne NAME OF DECEASED (Las GRADE Grade BRANCH OF SERVICE SOCIAL SECURITY NUMBER Nurn6ro oe ('Assurance Social e ORGANIZATION Organisation Detainee in Iraq NATION (e.g., United Slates) Pays Iraq DATE OF BIRTH Dale de naissance SEX Sex. ffi MALE Masculin q FEMALE Fenno, RACE Race MARITAL STATUS Etat Civil RELIGION Culla X CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce CATHOLIC PROTESTANT Protestant OTHER (Speedy) . Autre (Specdter) NEGROID Negriode MARRIED Marie Calholique SEPARATED Separe OTHER (Specify) Autre (Specifier) WIDOWED Veut JEWISH Jud NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decede avec le so cht STREET ADDRESS Domicile a (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compns) MEDICAL STATEMENT Declaration medlcale CAUSE OF DEATH (Enter only once cause per line) Cause du daces (N'indiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH intervene entre renegue el in daces 1 DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable de la mart! Arteriosclerotic Cardiovascular Disease ANTECEDENT CAUSES SymptOmes precurseurs de la mod . MORBID CONDITION. IF ANY, LEADING TO PRIMARY CAUSE Condition morblde, all y a lieu. menant a la cause primeire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'il y a lieu, ayant suscite la cause primalre OTHER SIGNIFICANT CONDITIONS 2 Autres conditions sIgnificativee MODE OF DEATH Condition de daces AUTOPSY PERFORMED Autopsie effectuee YES Dui riN0 Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mart suscitees par des causes eateneures MAJOR FINDINGS OF AUTOPSY Conclusions principales de l'autopsie x NATURAL Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du pathologists USA 6)(6)4 MAJ, MC, HOMICIDE Homicide WW2 DATE Date 25 Aug 2003 AVIATION ACCIDENT Accident a Anon • YES Out M NO Non DATE OF DEATH (Hour r ,.. , Da e de daces (rheum, e jour, le moil, Pannee) 13 Aug 2003 Abu Ghraib,, Iraq . I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSESAS STATED ABOVE J'ai examine les restes morlels du d6 funtel ie condus que le daces est survenu a ('Scare indiquee at a. la suite des causes enumerees ci-dessus NAME OF MEDICAL OFFICER Nom du m6dicin militaire ou du man sanitaire TITLE OR DEGREE Titre ou dipldrne Deputy Medical Examiner b)(6)2 GRADE Grade MAJ INSTALLATION OR ADDRESS Installation ou ad esse Dover AFB, DE 19902 DATE Date /CV,'' 6)(6)-2 i State disease. i ty Or complication which 2 Stale conditions contributing to the death, but 1 Preciser la nature de le maladie, de la blessure 2 Preciser Is condition qui a contribue a la mon, ,:n.r4crt.rvooli t; mot ' r on mutrcrurtipily sac,, as MAW I ,enure, nit, not related to the disease or condition causing death. ou de la complication qui a contribue it M mon, mais non la maniere de mounr. delle qu 'un erred du coeur. etc mais Wayant aucun rapport avec la maladie ou a la condition qui a provoque la mon VVIAPR77 REPLACES DA FORM 3565, I JAN 72 AND DA FORM 3565-R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 189 DOD 003316 CERTIFICATE OF DEATH (OVERSEAS) Acte clid6COs (D'Outna-Mer) M I NAME OF DECEASED (Last, F irst Middle) NOM du decade (Nom et preno GRAPE Grade - BRANCH OF SERVICE Ar SECURITY NUMBER NUmero de !Assurance Semi e fit(6)-4' . ORGANIZATION ' Organisation Detainee in Iraq NATION (e.g., United States) Pays Iraq DATE OF BIRTH Date de naissance SEX Sexe n MALE Mascuiin q FEMALE Fermin RACE" - Race MARITAL STATUS Etat Civil RELIGION Culle CAUCASOID Caucasique SINGLE Cal ibataire DIVORCED DiVorce CATHOLIC PROTESTANT Protestant OTHER (Specify) Autre (Specifier) NEGROID Negriode MARRIED Marie Calholique SEPARATED OTHER (Specify) Senate A,.. -i . i!4. .(.S p. e, c ifier) WIDOWED Veuf JEWISH Jul NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec le susdit STREET ADDRESS Domicile A (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compos) MEDICAL STATEMENT Declaration medicale CAUSE OF DEATH (Enter only once cause per line) Cause du daces (N'indiquer qu'une cause par ligne) INTERVAL BETWEEN ONSET AND DEATH intervalle entre renegue el le deces DISEASE OR CONDITION DIRECTLY LEADING TO DEATH/ Maladie ou condition directement responsable de la ma. Arteriosclerotic Cardiovasular Disease ANTECEDENT CAUSES SymptOmes prectuseurS de la Mod. MORBID CONDITION. IF ANY, LEADING' TO PRIMARY CAUSE Condition morbide, s'il y a lieu. meant a la cause prirrialre • - • UNDERLYING CAUSE, - IF ANY, GIVING RISE TO PRIMARY ' CAUSE • Raison fondamentale, s'il y a lieu, ayant 'istikititi la cause primaire OTHER SIGNIFICANT CONDITIONS 2 Aulres conditions significetiVeit` MODE OF DEATH. Oondition de daces AUTOPSY PERFORMED Autopsie effecturie YES Oui ri NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mod suscitees par des causes eidereures AVIATION ACCIDENT Accident it Avion • YES Oui M NO Non MAJOR FINDINGS OF AUTOPSY Conclusions principales de l'autopsie 3C NATURAL •• Mod nalurelle .... ACCIDENT Mont aCCidentelle SUICIDE NAME OF PATHOLOGIST - Nom du pathologiste b)(8)-2 Suicide ' MAJ MC- A b)(6)-2 HOMICIDE Homicide b)03)-2 DATE Date 22 Aug 2003 DATE OF DEATH (Hour way, tuunol, year) Da e de deces) (Theatre, le Jour, le mots, tarmac)) - 20 Aug 2003 • - ' ' •- PLACE-OF DEATH Lieu de daces Abu Ghraib Prison, Iraq I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS S rAl EL) ABOVE J'ai . examiniilesreMesmortels'dit de•funtel fe conch's qua le daces est survenu a rheure indiquee el 5.13 suite des causes enurnerees ni•dessus NAME OF MEDICAL OFFICER Nom du medicin militaire - oixdu medicin sanitaire TITLE OR DEGREE Tare ou dipldmC Deputy Medical Examiner b)(0)-2 GRADE Grade MAJ INSTALLATION OR ADDRESS Installation ou ad esse 'Dover AFB - DE 19902 - I'DATE - Date./ 2n fil )(6).2 • • . 1.. State diseaso, injury or complication which . Y W affrINE7,7, State conditions contributing (alba death, but not related to the disease or condition causing death. l Precise le nature de la maladie; dale blessere ou de la complication qui a cantribue it la mort, mais non la maniere de mount, telle qu Un arret du coeut, arc 2 Pre clear Is condition qUi diontribUe a el mort, mais n'ayant audit rapportavec la maladie ou a la condition qui a provoque la mort D ,F,s5^17 REPLACES DA FORM 35651 JAN 72 AND DA FORM 3565-R(PAS); 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 190 DOD 003317 CERTIFICATE OF DEATH (OVERSEAS) Acte de dimes (D'Outre-Mer) %NAME OF DECEASED (Last First Middle) Nom du decode (Nom et prenoms) GRADE Grade BRANCH OF SERVICE Anne SOCIAL SECURITY NUMBER Numero de ('Assurance Sociale (b)(6)-4 ORGANIZATION Organisation Detainee in Iraq NATION (e.g., United Slates) Pays Iraq DATE OF BIRTH Dale de naissance 01 Jan 1941 SEX Sexe 121 MALE Masculin FEMALE Feminin RACE Race MARITALSTATUS elal Civil RELIGION Culte X. , • - .CAUCASOID Caucasique SINGLE Celibataire DIVORCED Divorce CATHOLIC PROTESTANT Protestant OTHER (Specify) Autre (Specifier) NEGROID Negriode MARRIED Marie Catholique Separ6 • OTHER (Specify) -.Aube (Specifier) . . SEPARATED WIDOWED Veut JEWISH Juil NAME OF NEXT OF KIN Nom du plus proche parent RELATIONSHIP TO DECEASED Parente du decade avec le susdit STREET ADDRESS Domicile a (Rue) CITY OR TOWN AND STATE (Include ZIP Code) Vile (Code postal compris) MEDICAL STATEMENT Declaration medlcale CAUSE OF DEATH (Enter only once cause per line) Cause du daces (N'indiquer qu'une cause per ligne) INTERVAL BETWEEN ONSET AND DEATH Intervene entre l'attaque et le dikes DISEASE OR CONDITION DIRECTLY LEADING TO DEATH ( Maladie ou condition directement responsable de la more. Atherosclerotic Cardiovascular Disease Resulting in Cardiac Tamponade ANTECEDENT CAUSES - Symptemes precurseurs de la iron. MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition rnorbide, all y a lieu. rnenant a la cause primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'it y a lieu, ayant suscite la cause unmake OTHER SIGNIFICANT CONDITIONS 2 Autres conditions significatives 2 MODE OF DEATH Condition de decks AUTOPSY PERFORMED Aulopsle effec u6e RYES Oui In NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES de I,': :non suscitees par des causes exterieures MAJOR FINDINGS OF AUTOPSY Conclusions prindpales de l'autopsle NATURAL :Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide - NAME OF PATHOI OOINSTomdu pathologists X6)-2 I MIR Mr: i ISN :13)(6)-2 , . HOMICIDE Homicide DATE Date 11 Jan 2004 AVIATION ACCIDENT Accident a Avian • YES OS t "A NO Non DATE OF DEATH (Hour Da e de doses (rheum, ! 08 Jan 2004 - PLACE OF DEATH Lieu de decks Abu Ghraib, Iraq I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les testes models du de runlet le condus sue to daces est survenu a l'heure indiquee et a, la suite des causes enumeress ci-dessus. NAME OF MEDICAL OFFICER Nom du medIcin mIlltaire ou du mbdlcln sanitaire TITLE OR DEGREE Titre ou diplOme Chief Deputy Medical Examiner ;bj(6)-2 GRADE Grade )CDR INSTALLATION OR ADDRESS Installation ou adresse OnvPr AAR nP 1Aan9 SIC 12)(6)-2 DATE. Date I . An /A 1°2- 4'0 State disease,- injury or complication which caus '4. State conditionscontributing to the death, but nt 1Preciser la nature de le-ma/wile, de la blessum ,4 Un oriel du coeur. etc Preciser la condition qui a contribue Ala molt. nalsrr ayanr auLun reopen avec ia melodic, ou a le condition qui a provoque In molt. , I JAN 72 AND DA FORM 3565-R(PAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 191 DOD 003318 BRANCH OF SERVICE Arme CERTIFICATE OF DEATH (OVERSEAS) Acte de dimes (D'Qutre-Mer) "Vj .44,11AISF fIV Ir1CfsrACM /I A. 4, bX13).4 renoms) GRADE Grade SOCIAL SECURITY NUMBER Ruiner° de ('Assurance Sociale ORGANIZATION Organisation Detainee in 'Iraq NATION (e.g., United States) Pays Iraq DATE OF BIRTH Date de naissance SEX Sexe 121 MALE Masculin FEMALE Feminin RACE Race MARITAL STATUS .Etat Civil RELIGION Cute X, CAUCASOID Caucasique SINGLE Calibataire OTHER (Specify) DIVORCED Autre (Specifier) Divorce NEGROID Negriode MARRIED Marie JEWISH Jut! OTHER (Specify) Autre (Specifier) WIDOWED Veuf SEPARATED Separe CATHOLIC Celholique PROTESTANT Protestant NAME OF- NEXT OF KIN Nom do plus,proche parent RELATIONSHIP TO DECEASED Parente du deckle aver le susdit CITY OR TOWN AND STATE (Include ZIP Code) Ville (Code postal compris) MEDICAL STATEMENT Declaration medicate STREET ADDRESS Domicile a (Rue) INTERVAL BETWEEN ONSET AND DEATH Intervene entre I'attaque at le dices CAUSE OF DEATH (Enter only once cause per line) Cause du dices (N'indiquer qu'une cause par ligne) DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Maladie ou condition directement responsable de Ia more. Myocarditis MORBID CONDITION. IF ANY. LEADING TO PRIMARY CAUSE Condition morbid?. s'il y a lieu. menant a la cause, primaire UNDERLYING CAUSE, IF ANY, GIVING RISE TO PRIMARY CAUSE Raison londamentale, s tl y a lieu, ayant suscite to cause primaire ANTECEDENT CAUSES Symptemes preourseurs de la mort. OTHER SIGNIFICANT CONDITIONS MMus conditions significative? MODE OF DEATH Condition de dimes AUTOPSY PERFORMED Autopsie effectuee RIVES Oui MAJOR FINDINGS OF AUTOPSY Conclusions principales de l'autopsie n NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mort suscitees par des causes etterieures X 'NATURAL Mort naturelle ACCIDENT Mort accidentelle SUICIDE Suicide HOMICIDE : Homicide NAIIC r1F OA I (ICT 1*(6)-2 :b)(8)-2 om du pathologists CAPT, MC, USN DATE Date 02 Feb 2004 AVIATION ACCIDENT Accident a Avion YES Oui 171 NO Non DATE OF DEATH (Ho Date dudemes (thew.. , • 16 Jan 2004 PLACE OF DEATH Lieu de deces Iraq I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine les reates mortels du de tuntel le =clue que le dikes est survenu a l'heure indiquee et a, la suite des causes enumerees ci-dessus. NAME OF MEDICAL OFFICER Nom du medicin militaire ou du medicin sanitaire .b)(111)-2 TITLE OR DEGREE Titre ou diplame Armed Forces Medical Examiner GRADE Grade CDR INSTALLATION OR ADDRESS Installation Cu adrease Dover. AFB, DE 19902 DATE Dale b)(13)-2 ^ 1^ • - ^ • • I State disease, injury or complication which Part failure, etc. 2 Stale conditions contributing to the death, but not related to the disease or condition causing death. I Pn3clser la nature de la maladie, de Ia blessure ou de la complication qui a contribua it la mort, mals non la maniere as mourir, tells qu 'un arrat du coeur, etc Pnkiser la condition qui a cantribue a Ia mort, mals n'ayant aucun rapport avec la maladle ou 8 Ia condition qui a provoque la mort. DD,Fs51,2064 REPLACES DA FORM 3565, I JAN 72 AND DA FORM 3565•RIPAS), 26 SEP 75, WHICH ARE OBSOLETE. MEDCOM - 192 DOD 003319 $6 sioARATED 6.4 CATHOLIC clattaaaw JEWISH Ant mown prla Ci MME WIDOWED v..., 1•00010110 Nh id. OTHER Isemlati Aim* ISTWO11..? q NO Non MODE OF DEATH Condidon de ciao CIRCUMSTANCES Sormoup4OING DEATH DUE TO ENT( FINAL CAUSES Epoonmence. dm le 0511 0.• aw rmanft.tafil.un. AuTorEs. renronmEo ~am. 4ENN.A. XLVES Oul MAJOR EsivarNCS OF AUTOPSY Conclusions W.00 14• CIF rtot.o.I. TITLE. OR DEGREE 'Nonce diltatni 1,L,1 c-/FlitbiC.O4 i. a'>4 41-** ta_ DATE DM* C> PI ° C> 1 INSTALLATION OR A00 alms lonelmfori ou mow. C. OC-7 1- 14 4.1.. A- 12_,A4 &rt, Fon_ r-te "Int /IL rz_ sicarcutU .b)(6)-2 SUICIDE WOW b)(6)-2 l HOMICIDN S1 6 Avian 12(N 0 Num DATE Dem AVIATION ACCIDENT AeOht.". e? oo Lieu de dki. CITES Oul g At 'b ., n Pa CA_ SEN Sib* )(MALE M.0.01. q - FEMALE ' 141nOrui1' SOCIAL SECURITY ,HUNISER Numbs do r AiNIT.P. Societe Moe OF NEXT OF ION NOM CIO pi- Orsalve 05511 t1/411• lb Lt./. la TREET ADDRESS Dennelli RINI A) Ai la W 11-1 RELATIONSHIP To DECEASED Front. du doldtl• WWI le wall. CITY OR TOWN AND STATE OnthNIC ZIP Coda VIII, ICOd• room comorIll MEDICAL STATEMENT 1:1;cto1Ilo1 Meanie MORBID CONDITION. IF ANT, LEAD.wo TO peplum/1Y CAUSE . Conallion meralcie, 511 y e IN.,. moment i M tWIDO POM O* LINDE RLYINEt CAUSE. IP ANY, DIVING RISE T0 PRIMARY CAUSE Nelson Tandem...MA y e P.V. wane ewelti le swim OrInwInt ANTECEDENT CAUSES Symmetries oticutiewt de lemon. DTNER SIGNIFICANT CONDiTio.OF Awn' conchae.. IdOnIllerIVIPO prZ., rh 5^..i DATE OF MATS (Nom ds -Dew de died. (Moo*, Irnser. It me* tennW I fri-Lityvyr a. 0 Co si I HAVE VIEWED TNF REMAINS OF THE. DECEASED AND DEATH OCCURRED A? TOE TIME INDICATED RHO PROM TME CAUSES AS STATED ASOVE. enillan3 Ie. woo manes du 04155I M le Wenn. Aim le etas vonrnw E vitAn. RIEINME n t N tutu tl,. OlewINI 411.1.44.10 el•dwpo" MEDCOM - 193 DOD 003320 GRADE Croft NATION 0.2, pnleteIgnuepi PUT' rz. cx sptAm CN Atir# DATE- OF SI irrtm Ono de OMMe.... UN szo A., 1.1 us nil manors. meto Nem, du/riddle's nallifIre wit de .401.1..m1nOte (b)(8).2 GRADS D,ote bo... c u .54.) CERTIFICATE 4 DEATH fOVERTEAS I Acte da &teas (IYOuvrosfer) Num 0. diekln (Nem M0diteinD u)(6).4 AGAIJCASO CaUcieMile PROTESTANT IttmeMsnt RELIGION ow. U/) CA./ OAakt'S/ 7-.160.SII OR CONDITION DIRECTLYLEAOINO TO DEATH . 0u eendldon eilnetermed teloonamne de le marl, I s1}to -1- 6-Lw v),' V- 6' -'1" CAUSE OF DEATH fEnter.eulUu••••te 00? _119.0 dicic (Artnelquer wimp ....Aegis' no..1 MARITAL STATUS Elm 61.11 DIVORCED Divorce • SINGLE 04111ENIN NAME OF EIECE ABED Moat. RM. HMI101 6E6)-4 SANIEATION almaMao. INTERVAL SETWEEN --- ONSET AND DEATH ItitaPrils - hrebirept wt N sii,tio C-1:3 -b 5 (bX6)-2 Death: 8/18/2004 Med. Examiner Location Autopsy Report: Date DC Signed Abu Ghraib Prelim 8/30/2004 04-630 ..b)(61-4 Date Autopsy Med. Examiner Death: 8/18/2004 (b)(6)-2 Abu Ghraib Prelim 04-629 Date Autopsy 8/30/2004 ,b)(8)-4 8/30/2004 Location Autopsy Report: Date DC Signed 8/30/2004 Manner: Homicide COD: Shotgun wound of the head Circumstances: A group of prisoners at Abu Ghraib became unruly and the guards used lethal force to subdue the crowd. A shotgun was fired, killing the detainee. Manner: Homicide COD: Shotgun wound of the chest Circumstances: A group of prisoners at Abu Ghraib became unruly and the guards used lethal force to subdue the crowd. A shotgun was fired, killing the detainee. 04-434 Date Autopsy 6/19/2004 Med. Examiner Location Autopsy Report: Date DC Signed b)(6)-2 Abu Ghraib Pending 6/23/2004 b)(6).4 Death: 6/14/2004 04-435 Death: 6/10/2004 b)(51-2 Date Autopsy Med. Examiner 6/19/2004 Location Autopsy Report: Date DC Signed Abu Ghraib Pending 6/23/2004 Manner: Natural COD: Atherosclerotic cardiovascular disease Manner: Pending COD: Pending Circumstances: Made gasping sounds, found unconscious with no pulse. Circumstances: Collapsed while speaking to other detainees. Detainee Autopsy Summary 23-Sep-04 Thursday, September 23, 2004 Page 1 of 8 MEDCOM - 194 DOD 003321 Date Autopsy 6/1/2004 Med. Examiner Location 0)(6)-2 Abu Ghraib 0)(6)-4 04-387 Date Autopsy Med. Examiner Location Autopsy Report: 0)(6)-2 6/1/2004 Abu Ghraib Prelim 6/1/2004 :6X6)-2 Balad, Iraq Death: 5/24/2004 Date Autopsy Med. Examiner Location Autopsy Report: Date DC Signed Prelim 6/16/2004 04-357 Death: 4/28/2004 (00)-4 Death: 5/22/2004 Autopsy Report: Date DC Signed Prelim 6/7/2004 04-386 Manner: Homicide COD: Gunshot wound of abdomen (Combat-related) Circumstances: Iraqi male was shot in a firelight and died of wounds. 04-388 Death: 5/10/2004 Date DC Signed 6/14/2004 Manner: Natural COD: Atherosclerotic cardiovascular disease Circumstances: Died in US custody Manner: Natural COD: Peritonitis of undetermined etiology Circumstances: Detainee Autopsy Summary 23-Sep-04 Date Autopsy Med. Examiner Location Autopsy Report: Date DC Signed 5/18/2004 Baghdad, Ira Prelim 6/2/2004 Manner: Homicide COD: Multiple gunshot wounds Circumstances: Pending Thursday, September 23, , 2004 Page 2 018 MEDCOM - 195 DOD 003322 Date Autopsy 5/18/2004 (b)(6)-2 Med. Examiner 04-309 Death: 4/5/2004 'b)(8)-4 13)(6)-2 LSA Diamon Pending 5/14/2004 Death: 3/8/2004 3/10/2004 r 5/13/2004 )(0.2 Camp Cropp Final :1*(6}4 04-100 Date Autopsy Med. Examiner Location Autopsy Report: b)(6)-2' FOB Ironhor. Prelim 2/28/2004 Death: 2/7/2004 Date DC Signed 5/13/2004 Manner: Natural COD: ASCVD Death: 5/11/2004 Location Autopsy Report: Date DC Signed Abu Ghraib Prelim 6/2/2004 04-358 .b)(8)-4 1,1(5)-4 Location Autopsy Report: Date DC Signed 04-110 Date Autopsy Med. Examiner Date Autopsy 4/26/2004 Med. Examiner Location Autopsy Report: Date DC Signed Manner: Pending COD: Pending Circumstances: Q by NSVVT, struggled/interrogated/died sleeping Manner; Natural COD: ASCVD Circumstances: Reported to medics with, chest pain Manner: Natural COD: Severe atherosclerotic cardiovascular disease Circumstances: Suspected MI Circumstances: Found in bed during headcount unresponsive Detainee Autopsy Summary 23-Sep-04 Thursday, September 23, 2004 MEDCOM - 196 Page 3 018 DOD 003323 Date Autopsy 2/28/2004 .b)(81-2 Med Examiner 04-038 Death: 1/16/2004 ,b)(8)4 :13)(8).2 Date Autopsy Met Examiner 2/2/2004 :bX6)-4 Death: 1/8/2004 04-014 Death: 1/9/2004 :b)(8)-4 Death: 2/19/2004 Location Autopsy Report: Date DC Signed Abu Ghraib Prelim 5/.13/2004 04-101 !b)(8)-4 Location Autopsy Report: Date DC Signed Abu. Ghraib Final 5/14/2004 04-012 Date Autopsy 1/11/2004 Med Examiner Location Autopsy Report: Date DC Signed Abu Ghraib Final 5/13/2004 Manner: Natural COD: Acute Peritonitis secondary to gastric ulcer Circumstances: Other detainees reported him in distress, unresponsive Manner: Natural COD: Myocarditis Circumstances: Collapsed during morning prayers Manner; Natural COD: CV Disease Circumstances: Brought to MPs by other Iraqis unresponsive Detainee Autopsy Summary 23-Sep-04 Date Autopsy Met Examiner Location Autopsy Report: Date DC Signed 1/11/2004 14M-2 FOB Rifles, Final 5/13/2004 Manner: Homicide COD: Blunt force injuries & asphyxia Circumstances: Q by OGA, gagged In standing restraint Thursday, September 23, 2004 Page 4 of MEDCOM - 197 DOD 003324 Manner: Homicide COD: Asphyxia due to smothering & chest compression Circumstances: Q by MI, died during interrogation Date Autopsy 12/2/2003 Death:. 11/26/2003. Date DC Signed 5/12/2004 03-571 bX6)-4 ,b)(6)-2 FOB Tiger;.. Final. Med. Examiner Location Autopsy Report: ;bX13)-2 03-504 Date Autopsy Med. Examiner 11/9/2003 b)(6)-4 Death: 11/4/2003 03-367A Death: 8/22/2003 Location Autopsy Report: Date DC Signed Abu Ghraib Final 5/13/2004 Manner: Homicide COD: Blunt force injuries complicated by rhabdomyolysis Circumstances: Found unresponsive while under guard by Afghan Mil forces Manner: Homicide COD: Blunt Force Injury complicated by compromised respiration Circumstances: Q by OGA and NSWT died during interrogation Date Autopsy 10/23/2003 Med. Examiner Location Autopsy Report: Date DC Signed :b)(6)-2 Camp Sathe Final 5/12/2004 Detainee Autopsy Summary 23-Sep-04 A03-144 (bX6)-4 Death: 6/11/2003 Date Autopsy Med. Examiner Location Autopsy Report: Date DC Signed 1111312003 ))(13)-2 FOB Geresh Final 11/13/2003 Manner: Accident COD: Heat Stroke Circumstances: Found on ground, in EPW Camp, Body temp 102 Thursday, September 23, 2004 Pogo 5 of 8 MEDCOM - 198 DOD 003325 Location Autopsy Report: Date DC. Signed .b)(0)-4 Death: 8/13/2003 03-385 Death: 8/7/2003 (b)(6)-4 13)(6)-2 Med. Examiner Location Autopsy Report: Diwania, Iraq Final 03-386 Death: 8/8/2003 '13)(111)-4 (b)(6)-2 Date Autopsy Med. Examiner 8/24/2003 Abu Ghraib Final 5/14/2004 03-369 Death: 8/20/2003 b)(6)-4 8/22/2003 13)(6}2 Manner: Natural COD: ASCVD 03-368 Date Autopsy 8/25/2003 Med. Examiner !b)(6)-2 Abu. Ghraib Final 5/12/2004 Date Autopsy 8/24/2003 Date DC Signed 5/14/2004 Location Autopsy Report: Date DC Signed Date Autopsy Med. Examiner Location Autopsy Report: Date DC Signed Abu Ghraib Final 5/12/2004 Manner: Natural COD: ASCVD Circumstances: Brought to MPs by other Iraqis unresponsive Manner: Natural . COD: Undetermined atraumatic cause Circumstances: Distress during tranport by 115th MP - later died Manner: Natural COD: ASCVD/Diabetes Circumstances: Chest pain following a fast. Circumstances: Taken to medics gasping for air Detainee Autopsy Summary 23-Sep-04 Thursday, September 23, 2004 Page 6 of 8 MEDCOM - 199 DOD 003326 03-366B Death: 8/11/2003 :b)(6)-4 03-349B Death: 7/12/2003 *.b)(8)-4 Camp. Cropp Final 5/14/2004 03-273 Death: 6/13/2003 (b)(8)-4 Date Autopsy Med. Examiner 6/17/2003 Location Autopsy Report: Date DC Signed Abu Ghraib Final 5/14/2004 A03-051 (b)(6)-4 Death: 6/6/2003 (b)(8)-2 Date Autopsy Med. Examiner 6/10/2003 Date Autopsy Med. Examiner Location Autopsy Report: Date DC Signed 8/11/2003 ,b)(8)2 Abu Ghraib Final 5/12/2004 Date Autopsy MaL Examiner 7/13/2003 Location Autopsy Report: Date DC Signed Location Autopsy Report: Nasiriyah, Ir Final Date DC Signed 6/10/2003 Manner: Natural COD: ASCVD Circumstances: No history Manner: Natural COD: Massive hemoptysis due to tuberculosis Circumstances: Pulmonary hemorrhage from TI3 Manner: Homicide COD: Closed head Injury; Cortical brain contusion and subdural hematoma Circumstances: Died 12 hrs post escape attempt - subdued by force Manner Hoinicide COD: Strangulation Circumstances: Found unresponisvie outside Isolation unit Detainee Autopsy Summary 23-Sep-04 Thursday, September 23, 2004 Page 7 01'8 MEDCOM - 200 DOD 003327 Date Autopsy 12/8/2002 Med. Examiner Location Autopsy Report: Date DC Signed !bX6)-2 Bagram,. Afg Final 12/14/2002 Detainee Autopsy Summary 23-Sep,04 A02-095 :bX6)-4 Death: 12/10/2002 Date Autopsy Med. Examiner Location Autopsy Report: Date DC Signed 12/13/2002 b)(8)-2 Bagram, Afg Final 12/13/2002 Manner: Homicide COD: Blunt force injuries to lower extremities complicating coronary artery disease Circumstances: Found unresponsive in his cell. A02-093 (b)(6)-4 Death: 12/3/2002 Manner: Homicide COD: Pulmonary embolism due to blunt force injuries to the legs Circumstances: Found unresponsive, restrained in his cell Thursday,.September2,3, 004 Page 8 of 8 MEDCOM - 201 DOD 003328 1 MEDCOM - 202 U, DOD 003329 A) Death Certificates: Natural / Iraq 11 B) Death Certificates: Accident / Iraq 1 C) Death Certificates: Homicide / Iraq 5 D) Death Certificates: Pending / Iraq 1 E) Death Certificates: , Homicide / Afghanistan 3 F) Autopsy Reports: Natural / Iraq fl. G) Autopsy Reports: Accident / Iraq 1 H) Autopsy Reports: Homicide / Iraq 5 I) Autopsy Reports: Homicide / Afghanistan 3 MEDCOM - 203 DOD 003330

Doc_nid: 
7031
Doc_type_num: 
72