It happened in the town of Mlawa on the twenty first day of August in the year nineteen hundred and four at ten o’clock in the morning. Szymsie [Shimon Alter son of Yitzhak Yakov Ha-Levy] Tachna, age forty three, tanner, residing in the town of Mlawa, appeared in the presence of the witnesses Moszek Ber Zagon, age sixty three, and Zoruch Mlawski, age fifty three, both of whom synagogue sextons residing in the town of Mlawa, and showed us a child of the male gender, declaring that it was born in the town of Mlawa on the fourteenth of August of the current year at five o’clock in the morning to his wedded wife Zysa [Tzippora daughter of Mikhael Ha-Cohen] née Kon, age forty two.  The child was given the name Dawid [Dovid son of Shimon Alter Ha-Levy]. This document was read to the testifier and the witnesses, signed by us and them.