[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[1], 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]

 

 

 

 

[1] [Tehran Cemetery]