[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Republic of Iran

Ministry of the Interior

National Organization for Civil Registration

 

Summary of Death Certificate

On the thirteenth day of the month of Esfand in the year sixty-two, 13 Esfand 1362 [3 March 1984], House/Business number ------ Street ------ Alley ------ City ------ Village/County ------ Hamlet ------ Town ------ [redacted] Mr. Seyyed Mohsen Razavi, Son of Seyyed Hasan and Hamideh, born in 1305 [1926-1927], birth certificate number [redacted], issued by City/County/Village [redacted], part of the hamlet ------ under the jurisdiction of the first branch of the Office of Statistics and Personal Status Registration of the town of Qorveh, died of illness/accident ------ and his death was recorded in the list of the deceased for 1362 [1983-1984] in the Behesht-e Zahra Branch, under the jurisdiction of the Office of Civil Registration of the town [Tehran], number 27474.

 

[This] copy of the summary of death was provided to Mr. Afshin Razavi without any alterations, or crossed-out sections, in response to his written request.