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English translation:

It happened in Mlawa eleven April, eighteen hundred and sixty five at two o’clock in the afternoon they came before me Levin Szmulowicz Landau, age seventy five, and Zalman Niborski, age fifty two, both teachers in the city of Mlawa, and they stated that on day ten of this month and year at twelve o’clock at night, died in Mlawa Moseik Dan [Moshe Dan son of Yitzhak Aryeh Ha-Levy], three weeks old son of Icek Lejb [Yitzhak Aryeh son of Moshe Mordechai Ha-Levy] and Brajna Laya [Brachah Leah daughter of Yisroel Eliezer Ha-Cohen], from maiden family Landau, both parents of name Tachna.  After seeing for certain to find out the child Mosiek Dan died, the act was seen and signed by those present.