[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

Date: 13/4/1363 [04/07/1984]

Number: 12575

(Series G)

 

[Emblem]

Islamic Republic of Iran

Tehran Municipal Council

Behesht-e Zahra

 

[stamp illegible]

 

The sum recorded in the table below was received [from] Mr. Kasiri for burial and was deposited to the credit of account number 91002 of the Cemeteries Organization of Tehran, at the Behesht-e Zahra [branch of] Melli Bank.

 

Bank Melli Iran

Behesht-e Zahra branch

 

[handwritten note and number at the bottom of the page]

[illegible]