Death Certificate of an 18 year old Iraqi male, an inmate at the Abu Ghraib prison, who was shot during the April 10, 2004 riot. He died from his injuries. No additional information available. Cause of death: gunshot wound.
0015-Jy—c..IP 1 '-I
Certificate Of Death
Internment Serial Number
For use of this form, see AR 180-8, the
Proponent agency is DCSOPS
To:
From:
l(b)(3).1
Service Number
lame(Last, First, MI) 'Grade
!Power Served !Place of Capture/Internment and Date
gationality
IZ-Iraq MC 348 105 2004/01/04
IZ-Iraq
lame, Relationship, Address of Next of Kin
Father,s First Name
b)(13)-4
Place Of Birth:
Date Of Birth:
1986/01/01
Place of Death Date Of Death Cause Of Death
BCF, 2004/04/10 GUNSHOT WOUND
Place Of Burial Date Of Burial Identification Of Grave
2004/04/11
Personal Effects: Please See Attached Page
Brief Details Of Death And Burial: Please See Attached Page
Date
Do Not Write In This Space
2004/04/11
(Seal of the Office of The Provost Marshal
Signature of Commanding Officer
General)
Witnesses:
Signature Address
Signature Address
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L -k 8
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Internment Serial Number
Personal Effects And Money
Property Tag Description Qty Dispostation
Above List Of Items Is Correct
The
Signature Of Detainee
Brief Details Of Death/Burial By Person Who Cared For The DeceasedDuring Illness Or During Last
Moments (Doctor, Nurse, Minister of Religion, Fellow Internee). Death/Cremation Details.
INTERNEE WAS SHOT DURING RIOT ON 10 APRIL 2004
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