Mlawa, February the sixth, nineteen hundred and thirty four. Before the below undersigned Official of the Civil Registry for the Jewish population appeared today Zysia [Tzippora daughter of Mikhael Ha-Cohen] née Kohn Tachna, daughter of Michel and Cypra Ruchla (of the family Waser), born in eighteen hundred and sixty three, residing in Mlawa at Zdunska street two, widow, in the presence of the witnesses Zajnwel Langleben, age fifty four, residing in Mlawa at Niborska street sixteen, and Szaja Landau, age eighty, residing in Mlawa at Stary Rynek eighteen, and showed us a child of the female gender, born in Mlawa on the sixteenth of October, nineteen hundred and one, to her and her husband Szymsie [Shimon Alter son of Yitzhak Yakov Ha-Levy] Tachna, son of Icek Jankief [Yitzhak Yakov son of Yehudah Ha-Levy] and Chaja Laja [Channah Leah daughter of Moshe Tzvi], who died in Mlawa in nineteen hundred and thirty three. This child was given the name Chana Laja [Channah Leah daughter of Shimon Alter Ha-Levy]. This document, delayed for family reasons, was read and signed by us and those who appeared.

 The notifier cannot write.

 Official of the Civil Registry, Mayor of the town of Mlawa.