Translated from Polish:

Death Record No. 22, Broniewo Parish, Radziejow, of Magdalena Maćkowska, who died in Broniewo on 13th December 1855, at 9 pm, death reported on 16th December 1855, at 5 pm, she lived 38 years, she was a laborer, widow, daughter of Józef and Agnieszka, married couple Gutowski, both already deceased. At death she left two children, Marianna and Józefa. Death reported by Franciszek Pałczyński, a laborer, 42 years old, and Marcin Kwiatkowski, a laborer, 31 years old. After confirming with my own eyes the death of Magdalena, this record was read and signed.