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English translation:

It happened in the town of Mlawa on the eighteenth of January, eighteen hundred and sixty four at eleven o'clock in the morning.  Izrael Hersz Kachna, shoemaker, thirty six years old, residing in the town of Mlawa, appeared in the presence of the witnesses, Zelman Niborski, fifty one years old, and Abram Bajlowicz, forty nine years old, both of whom synagogue sextons residing in the town of Mlawa, and showed us a child of female gender, testifying that it was born in the town of Mlawa on the thirty first of December, eighteen hundred and sixty three at four o'clock in the morning to his wife, Ruchla Estera née Fradalowicz, twenty eight years old.  This child was given the name Fajga.  This document was read to the testifier and the witnesses and signed by them, whereas the father of the child testified that he cannot write.