Bu metin Türkçe’den İngilizce’ye çevrilmiş olup telif hakkına tabidir.
Hukukçu yeminli tercüman tarafından yapılmasını istediğiniz hukuki metin çevirileri için,
[email protected] adresine e-posta atarak fiyat teklifi alabilirsiniz.
DEATH CERTIFICATE
This copy shall be used as the certificate of death Form number: 0814….
Information of the Province BURSA Municipality Republic of Turkey
institution issued the Neighborhood Nilüfer Municipality
death certificate hereby District NİLÜFER
.
A Information Related the Decedent C Way of the Death
TR Identity 345 221 …. X Natural Death -Traffic Accident - Other
Number - Suicide -Work Accident - Being investigated
- Murder - Other Accidents - Not known
Nationality Turkish
Name and D Was the death caused by an accident
Surname
Father’s Name - Yes X No (Then go to the section E)
Mother’s Name
Date of Birth
The district
where she was
registered
Volume No: Family Range No: E Was the autopsy performed?
Individual Range No: - YES X NO (Then go to the section F)
Sexuality FEMALE
Graduation HIGH SCHOOL Were the death reasons found out by the autopsy ?
Occupation RETIRED - YES X NO (Then go to the section F)
Permanent Province : BURSA
Residence Possibility of getting new information?
District : NİLÜFER - YES X NO (Then go to the section F)
Neighborhood :
Abroad
The decedent whose name, surname and other identity information were given in the death certificate hereby, was allowed to
have been buried. The medical doctor has to mark the boxes F,G and H.
Information of the person
providing the knowledge about the The medical doctor filled the form
decedent
Name - Name - Dr. Yaşar…
Surname Surname
Phone number Title Medical Doctor, Dip No. T99…, Ratification No. …
Degree of Date 20/07/…
affinity Spouse
Signature Wet signature Signature / (Wet Signature)
Cachet
F Dead Birth - YES X NO (Then go to the section G)
Infant Death - YES X NO (Then go to the section G)
G This section will be filled if the decedent is a female
X The death is not a die in childbirth
H Death reason The approximate time passed from the beginning of the illness to the death
SECTION I
The illness or situation
directly caused to the death a) CEREBROVASCULAR ILLNESS 20 DAYS
Former Reasons b) BRAIN TUMOR, RADIOTHERAPHY, CHEMOTHERAPY MONTHS
Any other reasons behind the c) BRAIN TUMOR, OPERATIONS 2 YEARS
illness of situation causing
the death d) GLIOBLASTOMA MULTIFORME 2 YEARS
SECTION II
Other reasons that have effect
on the death but does not
directly linked with the illness
or situation causing the death.
This section is for the information of illness, wounding or complication that caused the death. The reasons of death such as
heart arrest or respiratory insufficiency should not be written in this section.
THIS DOCUMENT IS A CERTIFIED COPY
Dr. ŞEREF…
Nilüfer Municipality
Deputy Manager of Health Service
(Wet Signature)
