Translated from Russian:

Death Record No. 18, Blizanów, Kalisz, Wielkopolskie, of Wojciech Kucharzak, who died in Janków on 1st April 1870, (no hour given), death reported on 2nd April 1870, at 1 pm, he lived 43 years. He was son of deceased Walenty Kucharzak and of his wife, Anna, born Bartosik, laborers in Janków, he was born in Biskupice, of this Parish, and lived in Janków. At death he left widowed wife, Jadwiga, born Jędrusiak. After confirming with my own eyes the death of Wojciech Kucharzak, this record was read and signed.