[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Republic of Iran

Regional Health Organization, East Azerbaijan

 

Particulars of the Deceased

 

Name: Azizollah, Surname: Ashjari, birth certificate number ----- place of issue ----- date of birth ----- father’s name: Mohammad Ali, residential address: ----- approximate length of illness: ----- direct cause of death: [executed in prison] under the provisions of Sharia Law , other minor causes[of death] ----- on date: 27/8/1364 [18 November 1985] at age ----- at place ----- died and by virtue of this certificate, permission is granted for the body to be buried.

 

Signature of the physician [illegible name] [signature]

 

[Official stamp]

 

[Handwritten note in the middle of the page]

By virtue of Order number 14/3477 [dated:] 11/8/64 [2 November 1985]