[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

The Personal Status Registration Office

Excerpt from Death Certificate

15/1/1363 [4 April, 1984]

 

On 15 Farvardin 1363 [4 April 1984], house number ... Street ... city of Tehran ... rural district … county …, Mr. Yadollah Saberian, son of Mohammad Hasan and Kheriolnesa, born in 1299 [1920], holder of Identification Number [redacted] issued in the Semnan region, within rural district … in area 1 of the Personal Status Registry Office in Semnan County, has died and his death was registered in the Deceased Registry records for year 1363 [1984] Tehran -Behesht e Zahra, with [assigned] number 1672 dated 28/1/1363 [17 April 1984].

This copy of the Death Certificate, intact and unmodified, was produced at the written request of Mrs. Molok Nourelddin daughter of …

Signature of the Representative and seal, Tehran area, The Personal Status Registry Office

[signature over official stamp]