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English translation:

It happened in the city of Mlawa, eight June, eighteen hundred sixty five at eleven in the morning, came Icek Jakub [Yitzhak Yakov son of Yehudah Ha-Levy] Tachna, a leather peddler aged thirty two and living in Mlawa, in presence of witnesses Levin Szmulowicz Landau, age seventy five, and Zalman Niborski, age fifty two, both teachers in the city Mlawa and living there.  They show us a child, female, informing us the child was born in Mlawa on fifteen December, eighteen hundred sixty two at six o’clock in the morning from wife Chani Laya [Channah Leah daughter of Moshe Tzvi], she was of maiden name Cytryn, age twenty eight.  The child was named Chaya [Chaya daughter of Yitzhak Yakov Ha-Levy].  The late announcement of the date was the fault of the father.  The act was written and signed by everyone.