It happened in the town of Mlawa on the sixth of March, eighteen hundred and seventy two at five o’clock in the evening. Józef Baranowski, age sixty one, and Zelman Niborski, age fifty nine, both of whom synagogue sextons residing in the town of Mlawa, appeared and declared that on the fifth of March, eighteen hundred and seventy two at eleven o‘clock at night died in the town of Mlawa Jura [Sura] Tachna, five years old, daughter of Icek and Chana Laja née Cytryn married couple Tachna, born in the town of Mlawa. After having convinced ourselves with our own eyes about the passing of Jura Tachna this document was read aloud and signed by the declarants.

 The Holder of the Civil Records              

illegible

Zelman Niborski