[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
Islamic Republic of Iran
Ministry of the Interior
National Organization for Civil Registration
Extract from Death Registry,
On the sixth of Aban sixty three, 6/8/1363 [28 October 1984], in the county of Tehran, Tehran [Province], Mr. Younes, surname: Nawruzi-Iranzad, son of Abdollah and Masoumeh, born in 1305 [1926-1927], birth certificate number [redacted], issued at [redacted], died, and his death was registered in the Death Registry of the year 1363 [1984/85] at Behesht-e Zahra, of the county, under the number 16955.
This copy of the death summary is unblemished and has been submitted to Mr. Afshin Nawruzi-Iranzad upon his written request.
Signature [place] of the representative of Behesht-e Zahra Region, Department of Civil Registration of Tehran County
034128 / 14/8/1363 [5 November 1984]
 [Tehran Cemetery]