Translated from Russian:

Birth Record No. 9, Pamięcin Parish, Kalisz, Wielkopolska, Poland, of Joanna Sipka, born in village Poklęków on 28th January 1914, at 8 pm, christened on 2nd February, at 10 am, daughter of Maksymilian Sipka, a peasant living in village Poklęków, 32 years old, and of his wife, Pelagia, born Kordylas, 28 years old. Witnesses: Wojciech Raszewski, 30 years old, and Franciszek Dębowski, 40 years old, both peasants living in village Poklęków. Godparents: Franciszek Dębowski and Antonina Kordylas. This record was read to the one presenting and to witnesses and signed.