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English translation:

It happened in Kossuty on the twentieth of August/first of September eighteen hundred forty six at five o’clock in the afternoon.  The Jews Gimpel Jankielowicz Tandeta, age fifty six, and Herszko Leybowicz Donicki, age forty seven, both of whom are synagogue sextons residing in Zareby Koscielne, appeared and testified that on the day of today at ten o’clock in the morning died the Jew Herszko Josko [Tzvi Yosef] two given names Leybowicz Tachna, age sixty, house owner in Zaremby, leaving his wife Szeyne [Shayna] Jankielowna residing in Zaremby.  After having convinced ourselves with our own eyes of the death of the Jew Herszko Josko two given names Leybowicz Tachna, this document was read to those who appeared, who are not related to the deceased, and signed by us, the Holder of the Vital Records, whereas the witnesses testified that they cannot write.