[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Republic of Iran

Ministry of Interior

National Organization for Civil Registration

Synopsis of Death Certificate number 871809 - F/7

 

On, dated: unknown, in the City of Sabzevar, Village of Sad Khosrow, Town of Sabzevar, Mr. Seyyed Fereidoun, Surname Kamizi, Son of Seyyed Mahmoud and Olya, Born in 1334 [1955], Birth certificate number [redacted], Issued in the Village of Sad-Khosrow, District 5 of the Office of Civil Registry of Sabzevar  has died, and his death has been entered in the registry for deceased citizens, in year 1375 [1996], District 5 of the Civil Registration Office of Sabzevar, under number 10837.

This copy of the [above] extract was delivered to Mr. Farhad Kamizi, his son [in response to] his written request without any errors and cross-offs.

Signature of the representative and seal of the Office of Civil Registry of Sabzevar area,

[Name and signature] [Javad Farsadizadeh]

26 Shahrivar 1379 [16 September 2000]

[Official stamp]

Office of Civil Registry of Sabzevar - Code: 231