CERTIFICATE of DEATH (OVEHSPAS) Acte dt jJflet? D Quirz-Meri

li UE OF DtCElifO Hit|I y-' «.'HHTF a.i HiHiX irinnn: i'lvim

IIBAYD HARHOOSil (-1AMED

oUA-ai c-n.ft

N.'A

iifiANtH OF 5 v E i'pvr so: ALECUHIT'. NUMStR Kfrj * • * infanta iiii (t)(6)

JHd 'iirt C-'i •?rlfli,.'.»c»;n LfSDlZ 7B06ICI CAMP 3UCCA TIF

IRAQ

OATE sr Bflrn Dii* -it fu ir+is*

01 JANUARY 1940

EP |f|i

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E h L Si A r; M = p, r Cic^i Ikiii -n .1.: il.

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--P T Kit!

>M»w» II i 'r i i

disease i : > J n utr' * Afra - T dl*T., V til i r t f i ^ - i i a r - h a: .r •_+: • it • j mgij PENETRATING TRAUMA TO HEAD

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MORTAR (BLAST

r,li~ft 1 QfjKqCMt CO'JSTiC'-S" Atjllrt CWTA4C 1 I HI' f

uoot OF rs^i CllinJlilWl 3"-

NJllUHaL MX nihl'lM ACClMHT

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H

Sm;iM 5 m; Kl*

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: HI f • • • f ir IVY" I 0745 09 JUNE 2007

P-.ACE or QfA-iH L-HU S»C»1 TIP CAMP BUCCA. IRAQ APO A^j>9375

. mJl'i F RTLWEO 1 HL PtM'^t,-:' '»: '• AW[J DEATH QCCUFIFLFRO AT THE TIM* Mljl TEC If E •"-.iS AS Alts im?1. i J'* lu <riUi I1WH" ii-j 1tM-i1 if IT 4-SIlH K n< mnrpnn 4 I'fuurt cv1|i>»t « i. IJ turn hie; inumliHinr>wii

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NSlH mt j.DTi n. :.-jir» 4u I 't TlTLi OP DESPLl run Bu MD EMERGENCE MEDtClNE

jnADE 0 4 TF J I CAMP BUCCA. IRAQ APO AE05>75

lb)3).T0 U.S C.

1 • . . • ,v iL. 1-1 *•<• I" • • »i|pV/>iifa4v i i • i i • • mjiFh^jwI.'i ji-JOv Jm.-I • i j*ii» -a Ji umrjc or Mjli'iM*^ ll^Ti • t'jn i i •• » J>rr litim <TIiiHTL- -.V- mwiiHiirm H" Ilk ....'r 1 i .Fi"V urn m 1 t ...I, , 1,1 -.1 iidn mlAh ,. .'.-I mui • -mJi A tl)J AM ri - .: i .".i rJ J» ini!iiiJiy I.i *Jir_ii| uur n i ."u _iH

DO F 206>1. APR "F977 'EPLACES a font* 145.1 • • . T - -•• sep == -• • . i. TJ5AP, vt »

10-L-0126 ACLU DD II (CENTCOM) 124

ACLU-RDI 5859 p.1

HOSPITAL REPORT DEATH 'II •„ r.ii fzMU -E! Afl Jir.i! ^CjCTCf '-J T-F i .ftJfSK SirUlii I NAME AMD LOCATE f KOSPlTftl

/ r t j f f t i e f w n j WfiJjcjt QHfisr >n rittefwante tyttl pftfitta >n one copy vfity, items, t tlrtvgl) r0 and sign iter, 7 7. ft™ ro ^fy'***' or Aawwwv* Utt&v print or :fpe wtfhea

Da' fi>t ""GMWy action tffltf fa, n'vps.'atsnn pf requires' numStf of copiii

SECTION A ATTENDING MEDICAL O-FICER S REPORT

PERSONAL DATA

1 PAT: fN ' D a t a (Patent s wd r ' - W Will br usad Id tmpwtt 'dunl'lyiug ct/Ha it wafltblel U B A Y n U R K O O S l f H A M E D

P S 9 J Z - H S O 6 0

R E G I S T E R ' S !

2 n ^ O F DEATH

<T-l5 0 9 J U N E 2 0 0 7

X MEDICAL E X A M I N E ^ COHONLR'SCASE

[X] • «0

1 PAT: fN ' D a t a (Patent s wd r ' - W Will br usad Id tmpwtt 'dunl'lyiug ct/Ha it wafltblel U B A Y n U R K O O S l f H A M E D

P S 9 J Z - H S O 6 0

R E G I S T E R ' S ! 4.

fS

lELrGiQN a Ch A PLAIN NOTlFJEO — I S tr* • ^C —

'-' ri ' i fnt •: -.>'11? 1 • r!rT. r i i r j'-r . T . ^ i i G<j[]0 accisl S i c u n i v Account Nfi . Register Number -ind Ward NuiriSir

4.

fS 1. 'VM " • a Ch A PLAIN NOTlFJEO — I S tr* • ^C —

'-' ri ' i fnt •: -.>'11? 1 • r!rT. r i i r j'-r . T . ^ i i G<j[]0 accisl S i c u n i v Account Nfi . Register Number -ind Ward NuiriSir

5 NAME, ADDRESS J N O RELATIONSHIP OF RELATIVE OR FRIEND FfltSENT AT DEATH

CAUSE OF DEATH APPROXIMATE i N f s ^ v A L

BETWEEN AND DEATH

Ti -. r M ilJNOIVCN OI'ECT-. • L±is TC -'= f"mj >j,i nLn; mtwn MtmeJt z' Ifypf r , rttir 'Jn'J'f, jjfffrrj Ik' V tfo+At III* tfrMJir ".u • • ••.'^piif jr*-.

DUE TO for as > Mns-Hjue'rc? of.i

r E h ' E T R . A T J N G T R A U M A T O H I i A D

nr-jf- it lo tisi*. "H'liii I'r u f iuni / i ; CDrvf-'Ofl J 5."J

DUE TO '<ir a consequence of) (l)

M O R I ARi J 3 L A 3 T nr-jf- it lo tisi*. "H'liii I'r u f iuni / i ; CDrvf-'Ofl J 5."J

121

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s i J I f L j : fA AN* CCi 'JB> • • V ,'iT--, t ^no " 3 TH( OtAth S:.- hST an-TEi"- fO j iS t i ' E Oft i a : 7i0m !JkuWrtl ir b

^ CiT[

0 9 June 2 0 0 7

15 r AJvE AMO GAAO^ Or MEDJCAL C^FlCE^

k I1

b}0>. 10 U.S.C. 130(b).(b)(Ci i

SECTION B - ADMINISTRATIVE

b}0>. 10 U.S.C. 130(b).(b)(Ci

TV(.E Qr qCTIOFl SAY g— MT i l l DP NES!?0*ML£ aft

• ; T i t fJ j tMf l . ro « * T * in Q" 0*KER AUrnOIUIED PE5H0H

i Et?T 1 &. 'jT AST 3:-'J! p i L N(JT|F if [J IWW( CHATE t o 0* OtCtASEO WWIED

li • hfJ ' . IAT L-'h 0f f>« NO'.f Itp r, JUST MJRT-JAHT afflC(ft«»t*>(0

•T REOCmChs^n&ti^ES

•a of"*' f3«t"TJ IS.

SECTION C i RECORD O f AUTOPSY 2C i .TiPS1. Ptn-d vji; ;jf ytL j,vr . -d^tzf

• 11 • NO ji AtiTOfw'OflOEfliQ

ii movisioiiialPAmoiOGiCAi twtr^rij

u nATj :f TV paj FJ Awfi AJW Uff AOS OF "hv 5ICIAH AjTCPSn 1c. Z:a 'J i T u Pi :( P n A N PiP' iHt/l-JO JVU*I TPS*

rv soitAweAHOiWttoefiffEfattTflAS SlCNAT'J-IE OI P.E-ilJTflAft

DA FOftM 3B94, OCT 72 KEPLACeS DA FORM 3-257 1 JAN 6 1. which VYJUE. 6E UStD •JSAVA VJ'J i

10-L-0126 ACLU DD II (CENTCOM) 125

ACLU-RDI 5859 p.2

— — — — — 0 0 6 0 5 4 CERTIF1C, c OF DEATH JEPft RIAL =

for us* i3l "vs f-jTn >E< A3 ian-5, ihi p' bpflnifni j i j ^ j y i* DC5PER LS^IZ-I FROM: "" * ' " TF 31st CAMP BUCCA. (RAQ A 3Q AEO^S

TO

L nave Lr.-'. V". Wt I-.EAYD HARHOOSH H A M E D

"j ? ADE M A

SERVILE ISN (b)(7)(E)

NATiOMALir* IPOW^PSFR^EC IRAQ

?LAC£ 0 * C Af>r.jqe INT;PMUEM T AND D FALLUJAH, IRAQ

Ft, AC* Of" EI^TH S A C L ^ W I A . IRAQ

oate at 5iHftn 01 JANUARY |y j6

NAM; - - L IE5S A^flcLATiOVSH.P Of NEXT Of F'RST NAME Cf PATHEin

PLACE Dc DEATH E-ATE GF C£AfH CAUSE ofoeath CAMP BUCCA, IRAQ 09 JUNE 2007 PENETRATING TRAUMA TO HEAD PLACE CF EUC'AL OAT; OF 5UPA1

lOEWTIFIJAriC^I Of GRAVE

P SON L EFFEil I S if" fc* flllitH ri>- *» fjjJjr • OtynyOdt} ff&pffj,* frMtinidr/J

RtJA.riE56VDETAiNlNGPOV.ER Ffl R Wfi RCEO WITH M Al>l • ARCED SWA RATE LV TO CCRWh: Atsip ts£tjis t liv^iiM

DRicf TAILS of ot ATH/BUAIAL BY WHO CA^ED FO* TME oeceaseo DWUNQ u n t s s OR DURHG LAST MOMHMS (ffntl,- IVN r I i WrjirKrCf/FIIJIJF'CL. F<.r:ov iitttrnte) iFtPEMAf^D GIVE'REASON < ff spat e if requireikfunllmit (AT HTWCJC •..••'; 1

DO NOT WRITE !N THIS *f3AL.: CTHTIHED A TRUE COPV

(

(>AT£ <B}(3) TD U.S.C I30IB),(B)(6) DO NOT WRITE !N THIS *f3AL.: CTHTIHED A TRUE COPV

( B)(3)'10 U.S.C

DO NOT WRITE !N THIS *f3AL.: CTHTIHED A TRUE COPV

( B)(3)'10 U.S.C

WRV ESSES ' . , E - * "

WRV ESSES

<BI(3). TO U.S.C I30(B>.FH)(EJ

»

AILDSESS

T F 31ST C A M P B U C C A I R A Q A P O A E 0 9 3 7 $

<BI(3). TO U.S.C I30(B>.FH)(EJ

» AOORE5S T F 31 SI C A M P B U C C A I R A Q A P O A E 0 9 3 7 5

D A F O R M 2 6 6 9 - R . M A Y 81: ^ n oft ,.• .,.. ; .•; j n u ^ r ^ v s * r * c y f . »

10-L-0126 ACLU DD II (CENTCOM) 126

ACLU-RDI 5859 p.3

MEDICAL FECORD CHRONOLOGICAL RECORD OF MEDICAL CARE

DATE SYMPTOMS. DIAGNOSIS TREATMENT. TREATING ORGANIZATION iS>cn etcn entry 1

Jv.L^TH JsS>m

M k l M i . .

..FT . p ^ T fAi^u^v

HOSJlTM OR MELflCAL Ftat.lTV STATES Of PART 'SERVICE RECORDS MAINTAINED AT

SPONSOR'S r-AUE SSh.'lU MO RELATIONSHIP TO S'ON&Ofi

fAT j'T a iCFNTi FICTION tfoi fWwiJ Sr •Vfi;ttf1 *n1tii% Jj'v4, • 4ffif. first .•rttdctfii.. io JShi -JT iJiM,

UTLAVD I-IARK005H HAMED

REGISTER MO w;fiC NC

JAN -DETAlttEfe

CHRONOLOGICAL RECORD 01= MEDICAL CARE Medicat ftecofd

STANDARD FORM 6 0 0 (RE1. S-97J Prescribed bv GSA^C^3

FIRfti'fl (41 CFRi 1 • iO^ ' LfSWAVi.QO

10-L-0126 ACLU DD II (CENTCOM) 127

ACLU-RDI 5859 p.4

STATEMENT Or IDENTIFICATION For MM I-1 m;i F(Jfm 4« rtp Tlv Ji-T'flOi cnl aytr-cv is OCCSPEfl

r.-w.r.p.

NAME •-- CEaSEd t*j[

UBAVD, HARHD&SH HAMIID

{WfrCE

SI DETAINEE

DATE jr INCICEV:

09JLN07 a n GAM 2A T ION A>:t DETAINEE

O i A TH . ' INCIDENT

CAMP RIJCCA CONDITION Cl? REMAINS 'DrSCribc britih >r> N*rrattve belj'.v i

Nn[ Micagn-iibie CompvtijKs Mijl ii; nn mfltf Otcs^poisii Sun Siritm

MEftWS OF IPEUT PICATH3N rOeu* n't jptot f r -• cr'•. c rrmg tfs n tn • Nam nvw sg wtvr J' F .j pr ill CflmPJ'iiOi s-i If f Ccmjl-jr .von OtfUU COnlturiiiH Antan.cil Con»fison

Pi-r-Lj-ji E'ipcti VttU*l RaCA ITi Btt idifltifiuTidn X f£tt>t»'r p'rt fljuj'r.f,

ENCLOSURES fttm 1 5 1 D D fi>-m DC f o r m a ? i

tO -aim 0 C f'i'T 9 r < i • • FCPTI S97 Ct r r t

g C Fapin 3 0 ? FD I F Form 137 5 f 6 0 3

O f TJI * P j v ; S F E f l SF N"I X Ot) F - rni

s11 eei X SF 600 X DDFORM3894 NARRATE .in3 f.-J ..T. •„•<• is rm-fs^ or ui* tdtHt^M ^oerj, ,f rts^'m

IDENTIFIED THROUGH D M 5 . IRIS .SCAN AMD PHOTOGRAPH

DA FORM 2773 . MAY 1399 PREVIOUS E C H I O N >5 CE5CLETE l APA v- JU

10-L-0126 ACLU DD II (CENTCOM) 128

ACLU-RDI 5859 p.5