[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
In the Name of God
Respected Deputy of the Organization
This is to advise that Rahim Rahimian, the spouse of the deceased, Mrs. Afagh Morad Ali, has requested her death certificate and the number of her gravesite. As he has presented all the necessary documents and receipt number 33720 in the sum of 9000 rial, you are accordingly instructed to issue the necessary orders as indicated in the enclosed documents.
28/1/1363 [17 April 1984]
Signature or fingerprint of the applicant