[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

 

Date: 28 Farvardin 1363 [17 April 1984]

Number: 3372

(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 Farvardin [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 Farvardin 1363 [17 April 1984]