[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
Islamic Republic of Iran]
Ministry of the Interior
National Organization for Civil Registration
Classified 3 – 1
Death Certificate Extract
On 19/7/1387, nineteenth day of the month of Mihr in the solar year one thousand and three hundred and eighty seven [10 October 2008], [in the] house –block number -----, -----street, -----district, city [of] -----, village of Kata, rural district of Sadat Mahmoudi in Dena county, Mr. Hosnollah Dadvaran, son of Moula and Shirin, born in 1305 [1926/7], of birth certificate number 97, issued in the village of Kata, part of Sadat Mahmoudi district, subsidiary of the Dena County’s regional registry office, died of old age and his death has been recorded in number 2046 of the regional death registry of the year 1387 [20018/9], subsidiary to the Dena County’s registry office.
This death certificate extract is provided free of any fault, blemish or crossing out, to Mr. Amanollah Davardan, son of Hosnollah, in response to his written request.
Space for the signature of the representative and the stamp of the Dena County’s regional registry office
[Stamp of the special registry office for death registration]
67/ 4 B 100 D 10000 -82N