[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

Islamic Republic of Iran

Ministry of the Interior

Personal Status Registration Office

Excerpt from Death Certificate

[illegible] 206227 Series 1-2

 

[illegible] Year: 1370 [1991]  House.....Number........Alley.........City of Tehran  [illegible] Village.......Town...... Mr. Bahman, Surname Samandari; Son of Azizollah and Bahiyyeh; Born 1318 [1939]; Identification number [redacted]; issued in the City of Tehran; part of Area 3 of the Personal Status Registration Office of ...... has died of illness/accident and his death has been registered in  book of the deceased [for] year 1371 [1992] of The Personal Status Registration Office of ...............at number 14042.

This intact and unmarred copy of the death excerpt was delivered to Mr./Mrs...........; Son/Daughter .......... in response to his/her written request.

[illegible] signature of the representative and stamp, [illegible] Tehran area, Personal Status Registry

[signature over official stamp]

[handwritten note, number and date at the bottom of the page]

Date of death 27/12/1370 [20 February 1992]

[official stamp]

[signature]