Forensic Medical Certificate for Seyed Khaleq Ahmadpur
Ministry of Health and Medical Education of the Islamic Republic of Iran
National Organization for Civil Registration
Medical Death Certificate for Individuals Over Seven Days of Age
System registration no.: 103-102833
Please read the instructions on the back of this form before completing it.
General Information of the Deceased:
Status of Birth Certificate: Holder of birth certificate
First Name: Seyed Khaleq
Last Name: Ahmadpur
Father’s name: Seyed Taher
National ID No.: 2872325514
Birth certificate number: 748
Place of Issue: Mahabad
Gender: Male
Nationality: Iranian
Occupation: Plasterer
Head of household's national ID no.: 2929643102
Education level: Middle School
Note: Complete items 12 to 15 if the deceased is older than seven days and under five years of age and the mother is alive.
Mother’s name and surname: Maryam Sabzeh
Date of birth of the deceased: November 11, 1988
Date of Death of the Deceased: November 18, 2022
Deceased’s address:
Permanent Residence: Mahabad County, City of Mahabad, Nabovat Sharqi Street, Second Alley, Iran, West Azerbaijan Province
Place of Death: Iran, West Azerbaijan Province, Mahabad County, City of Mahabad
Location of death: Hospital/Limited Surgery Center
Cause of Death:
Gunshot wound to the upper abdomen
Final illness or condition leading to death: Gunshot wound — [illegible]
[Signature and seal of the emergency physician affixed at the bottom of the page.]