[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
In the Name of God
The Personal Status Registration Office is obligated to investigate the religion [illegible] of those who believe in the Baha’i sect, in accordance with Verdict number [illegible] (5/12/1359) [24 February 1981]; therefore, please answer the following questions:
[signature]
Please introduce yourself: Ezzatollah Ahmadian
What is your religion? In accordance with Article 23 of the Constitution, it is prohibited to require an individual to identify his belief.
3- Please clarify in case your religion is other than Islam or one of the officially recognized religions of the Islamic Republic: I believe in all divine religions
Ezzatollah Ahmadian
[Signature]
9/1/1360 [29 March 1981]
4- Please state in writing if you believe in the religion of Islam, otherwise are you willing to convert to Islam? I do believe in God, the prophet hood of Moses, Jesus, and Mohammad the Messenger of God.
Ezzatollah Ahmadian
[Signature]
9/1/1360 [29 March 1981]