[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  House number-----, Alley-----, City of Tehran, [illegible], Village-----, Town-----, Mr. Bahman, Surname Samandari, Son of Azizollah and Bahiyyeh, Born 1318 , 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 the deceased book [for] year 1371  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 Esfand 1370 [17 March 1992]