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Translation:
No. 364
Delmenhorst, December 15, 1913
Before the undersigned registrar appeared today Mrs. Helena Bedry née Drexler, a factory worker, residing in Delmenhorst, Nelkenstraße 4, recognized by this birth register No. 588 from 1913, and stated that the factory worker Maria Poniuch, 25 years old, of Catholic religion, residing in Delmenhorst, Jutehäuser 17, born in Zukow district Zloczow on 4. July 1888, unmarried, daughter of the late worker Johann Poniuch, last residing in Zukow and his wife Maria née Lachowicz resident in Zukow, died on 13 December 1913 in the morning at 11 a.m. in Delmenhorst in this apartment, as she testified from her own knowledge.
Read out, approved and signed with three crosses by the notifier because she does not know how to write + + + .
The registrar. <signature>
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