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English translation:

It happened in Kossuty on the twenty second of November / fourth of December, eighteen hundred fifty four at ten o’clock in the morning.  The Jews Mosko Szaykowicz Luzym, age sixty five, both of whom are synagogue sextons residing in Zareby Koscielne, appeared and testified that yesterday at eight o’clock in the evening in Zareby Koscielne died the Jew Sora Dyna [Sara Dinah] two given names Judkowa Tachna, age sixty two, widow, day laborer, daughter of unknown parents, leaving her daughter Haia Feyga [Chaya Fayga daughter of Yehuda Ha-Levy] two given names Judkowna residing in Zareby Koscielne.  After having convinced ourselves with our own eyes of the death of the Jew Sora Dyna two given names Judkowa Tachna, this document was read to those who appeared, who are not related to the deceased, and signed by us, Official of the Civil Registry, whereas the witnesses testified that they cannot write.