[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
Date: 28/1/1363 [17 April 1984]
Number: 33720
(G Series)
[Emblem]
Islamic Republic of Iran
Tehran Municipal Council
Behesht e Zahra
The sum for burial recorded in the table below was received from Mr. Rahimian and was deposited in account number 91002 of the Cemeteries Organisation of Tehran, Behesht e Zahra Bank Melli
[illegible]
Sum received: 9000
Account number [illegible]
Date: 28/1[17 April]
Bank Melli Iran
Behesht e Zahra Kiosk
Warning: Receipts with an incomplete table by [illegible] are not valid
[handwritten note, signature and stamp at the top of the page]
[handwritten note, number and date at the bottom of the page]
Execution number [without any identity details]
Registry of Birth
1766
18/1/1363