[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Logo]

The Islamic Republic of Iran

Ministry of the Interior

National Organization for Civil Registration

 

[Official stamp on the space allocated for photo]

Excerpt from Death certificate

 

On, day: 17, month:4, year:61 of Solar calendar [8 July 1982], Home: ...City: Qazvin....in district of Qazvin, Mr. Manouchehr with the last name: Farzaneh-Moayyad, son of Hasan and Robabeh Soltan, born in 1305 [1926-27], with birth certificate number 38 [birth registry], issued in the city of Tehran, in Division 3 Hasanabad of the Personal Status Registration Office of Tehran, has died, and his death has been recorded with [registry] number 60 in the Death Registry Book of year 1361[1982-83], Division 3 of the Personal Status Registration Office of Qazvin.

Based on a written request, this excerpt from the death certificate was given to Mrs. Mehrangiz Samadani, the wife of the deceased, free of any errors, blemishes, or redacted words.

 

Space for the signature of the representative and the stamp of Division 3 [Metri] of the Personal Status Registration Office of the city of Qazvin

 

[Signature on the official stamp]

Abbas Nasiri [Signature]

Copy conforms to the original death certificate

[Signature on official stamp]