[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Republic of Iran

Municipality of Tehran

(Behesht-e-Zahra)[Tehran cemetery]

Death certificate

Number: 038159

Date: [Illegible]

Date of death 9 Esfand 1360 [28 February 1982]

Receipt number: [illegible]

Sum ----- rials

 

Name of deceased: Seyyed Hosein, Surname: Vahdat-Haqh, Father’s name:---- Mother’s name: ----, Birth Certificate number:----, Issued in: ----, Date of Birth: ----, Age: [60] years old, Occupation: ----, Nationality: Iranian, Place of death: Tehran (Qasr), Avenue: ----, Street: ----, Number: ----, Type of Illness: Execution by firing squad, Attending doctor or hospital: Tehran Public Prosecutor Office, Place of Burial: Behesht-e-Zahra, Plot [illegible], Presented by: ----, Surname: ----, ID card number: ----. Issued by: Revolutionary Court, Resident of District: Qasr Prison, Avenue: ----, Street: ----, Number: ----, Occupation: ----, Working at: ----.

Signature of presenting person:

Issued by (signature):

[Signature]

 

[Handwritten notes at top of page]

[Number:] 14463

Qasr Prison

Office of Munkarat[1]

[Official Stamp]

[Number:] 30/1318

 

[1] [Munkarat:  The organization that enforces Islamic values]