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English translation:

It happened in the town of Mlawa on the sixteenth of February, eighteen hundred and fifty nine at ten o'clock in the morning. The Jew Hersz Jablon, tailor, residing in Mlawa, thirty four years old, appeared in the presence of Lewin Szmulowicz Lando, seventy one years old, and Abram Bajlowicz, forty seven years old, both of whom synagogue sextons residing here in Mlawa, and showed us a child of female gender, testifying that it was born here in Mlawa on the fifteenth of September, eighteen hundred and fifty five at twelve o'clock at night to his wife, Gitla Frymet née Tachna, twenty three years old. This child was given the name Wechna Ryfka [Vehchanna Rivke]. This document was read to the testifier and the witnesses and signed together with us.