[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Republic of Iran

Ministry of the Interior

National Organization for Civil Registration

 

Excerpt from Death Certificate

 

On 6 Dey 1360 [27 December 1981], sixth of Dey one thousand three hundred and sixty, number ----- Street ----- Division ----- City of Tehran, Tehran County, Mr. Jalal, surname Azizi, son of Azizollah and Bibi-Jan, born in [redacted], birth certificate number [redacted], issued at [redacted], citizen of Region 3 Department of Civil Registration of Tehran County due to illness/accident ----- died and his death was registered in the Department of Civil Registration of Behesht-e Zahra, County number 16364 –  6 Bahman 1360 [26 January 1982].

 

This Excerpt from Death Certificate is submitted to Mr. Farzin Azizi, son of -----, without any scratch or alteration, as per his written request.  

Place of signature of representative and stamp of Tehran region, Department of Civil Registration of Behesht-e Zahra

 

6 Bahman 1360 [26 January 1982]

[Signature over official stamp]