[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

The Islamic Republic of Iran

Ministry of the Interior

National Organization for Civil Registration

Copy of the Death Certificate

3 Azar 1363 [24 November 1984]

 

On 13 Azar 1336 [4 December 1984] in the City of Tehran, Mr. Jamal, surnamed: Kashani; son of Ali-Akbar and [Bahereh]; born in [redacted], with birth certificate number; [redacted], issued from; City/Town; ….. Village; ….. of section 8 of the Civil Registration Office of the City of [redacted]; died due to: illness/accident: …...

His death has been registered at the National Organization for Civil Registration for the year 1363 [1984] of area; ….. of the Department of Civil Registration Office; Behesht e Zahra under the registration number: [illegible].

This copy of the death certificate has been issued without any defects, alterations or corrections, after the receipt of a written petition from Mr. /Mrs. [illegible], son/daughter of: [illegible].

 

Signature and Stamp of Behesht e Zahra

The Department of Civil Registration

[Signature over the official stamp]