Death Certificate: 18-Year-Old Iraqi Male; Abu Ghraib Prison, Iraq (Homicide) (0013-04-CID784-83982)

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.

Doc_type: 
Medical
Doc_rel_date: 
Sunday, April 17, 2005
Doc_text: 

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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MEDCOM - 549
DOD 003612

0 c.) I I (Y1
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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IS OBSOLETE
EDITION OF 1 Jul 63
Page 2
DA FORM 2669 -R-E, May 82
MEDCOM - 550
DOD 003613

Doc_nid: 
3332
Doc_type_num: 
72