[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
Form Number One
In the Name of God, the Compassionate, the Merciful
Order number 10B/191 dated 28/04/61 [19 July 1982]
Administered by: Preliminary Commission for the Restructuring of Human Resources,
Type of accusation: Membership in the perverse Baha’i sect
Procedural synopsis: Allegations brought against Mr. Heshmatollah, last name: Vafaei Moghaddam, son of: Bahramali, born in: 1308 [1929/1930], birth certificate number: [redacted] issued in: [redacted], organizational position: driver, work history: 31/07/1345 [23 October 1966], working in: motor pool unit, personnel number: [redacted], education level: sixth grade and married, was reviewed by this commission and after consideration of evidences presented during the session on 26/04/61 [17 July 1982] this commission provides its decision as follows:
Decision of the board
In the light of evidence provided by accused —x— and statements made by the witnesses —x— and affirmative evidence—x—, and taking into consideration other conditions and circumstantial evidence existing in this case, the charges against the accused are established and proven [to the satisfaction of] this commission. The offence of the named accused falls under
1-________ Subject of section 8 of Article 29 of the Human Resources Restructuring Act, [applicable to] Government Ministries and Affiliated Organizations, enacted on 05/07/1360 [27 September 1981] and in accordance with section 22 of Article 20 of the aforementioned Act, he is sentenced to permanent dismissal from government employment. As stipulated in Section 46 of the aforementioned Act, this decision is final and enforceable.
This decision is appealable within 15 days from the date [of service on] the accused, ---------------- or through other legal means, at the Appeals Commission.
From the Primary Board
[Signature over official stamp]
 [The seventh month, Mehr, is 30 days]