[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

Evin Prison

 

Date: 21 Aban 1360 [12 November 1981]

Number: 14065

 

The amount of 2,000 rials to be delivered to Mrs. Mahin-Lami’ Azizi, the prisoner of the section 246, by Mr./Mrs.…,

The name of the receiver of money: …

 

Signature

[Signature]

 

Attention: Be careful that the receipt does not get lost.

 

[Handwritten note at the top of the page]

Morteza

 

[Written note at the right side of the page]

Page 2 is for the receiver of money