[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

The Islamic Republic of Iran

Ministry of the Interior

National Organization for Civil Registration

 

Summary of Death Certificate

 

On the thirteenth day of the month of Esfand in the year sixty-two, 13/12/1362 [3 March 1984], House/Business number ------ Street ------ Alley ------ City ------ Village/County ------ Hamlet ------ Town ------ [redacted] Mr. Sayyid Mohsen Razavi, Son of Sayyid Hassan and Hamideh, born in 1305 [1926-1927], birth certificate number [redacted], issued by City/County/Village [illegible], part of the hamlet ------ under the jurisdiction of the first branch of the Office of Statistics and Personal Status Registration of the town of Gharveh, died of illness/accident ------ and his death was recorded in the list of the deceased for 1362 [1983-1984] in the Behesht-e Zahra Branch, under the jurisdiction of the Office of Civil Registration of the town [Tehran], number 27474.

 

[This] copy of the summary of death was provided to Mr. Afshin Razavi without any alterations, or crossed-out sections, in response to his written request.