[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Republic of Iran

Ministry of Interior

National Organization for Civil Registration

Synopsis of Death Certificate number F/7-871809

On, dated: unknown, in the City of Sabzevar, Village of Sad Khosrow, Town of Sabzevar, Mr. Sayyid Fereidoun, surname Kamizi, son of Sayyid Mahmoud and Olya, born in 1334 [1955], birth certificate number [redacted], issued in the Village of [redacted], District 5 of the Office of Civil Registry of Sabzevar, has died, and his death has been entered in the registry for deceased citizens, in year 1375 [1996], District 5 of the Civil Registration Office of Sabzevar, under number [redacted].

This copy of the [above] extract was delivered to Mr. Farhad Kamizi, son of Khish, [in response to] his written request without any errors and cross-offs.

 

Signature of the representative and seal of the Office of Civil Registry of Sabzevar area,

[name and signature] [Javad Farsadi Zadeh]

26/6/1379 [16 September 2000]

 

[official stamp]

Office of Civil Registry of Sabzevar

Code: 231