Burial Permit for Jamshid Mokhtari
Emblem of Forensic Medicine Organization of Judiciary
General Forensic Medicine Department of Chaharmahal and Bakhtiari Province
Shahr-e Kord County Forensic Medicine Department
Burial Permit
Permit No.: 194
Date of issue: May 18, 2022
Information about the deceased:
Identity: Identified
Gender: Male
Nationality: Iranian
Last Name: Mokhtari Junaqani
First name: Jamshid
Father's Name: Gholam Ali
National ID Number: 4679770082
Birth Certificate Number: 98
Birth Certificate Serial Number: 137962 / 13-A
Place of Birth:
Province: Farsan
Town: Junaqan
Date of Birth: May 31, 1983
Age: 39 years old
Date of death: May 17, 2022
Cause of death:
(a) Respiratory failure
(b) Rupture of left and right lung
(c) High velocity metal projectile strike (military weapon)
"The burial of the deceased is authorized."
Issuer of the burial permit:
Name of forensic doctor: Dr. Mohammad Reza Nurian
Medical License Number: 81445
Signature of Forensic Doctor
Attestation and Seal of the Notary Public's Office, dated: May 30, 2022 (09/03/1401)
"Photocopy certified as a true copy of the document submitted to the Notary Public Office".
Notary Office No.: 20, Junaqan
Address of the deceased:
Permanent residence of the deceased:
Country: Iran
Province: Chaharmahal and Bakhtiari
County: Farsan
District: Junaqan
City: Junaqan
Street: Navab Safavi
Postal Code: 8867135445
Place of death (as reported by relatives)
Country: Iran
Province: Chaharmahal and Bakhtiari
County: Farsan
District: Junaqan
City: Junaqan
The white copy is for burial purposes and is intended for cemetery units under the jurisdiction of the municipality, while the green copy is for the civil registry organization.
Form number: 007391
