Translated from Polish:

Death Record No. 75, Konin, Evangelical Parish, of Dorota Milbrat, born Kumant, who died in Golina on the 18th November 1841, death reported on the 19th November 1841, she lived 40 years. At death she left widowed husband, Wilhelm Milbrat, a miller in Golina, and 5 children. Death reported by August Milbrat, a miller from Kraśnica, 36 years old, and Bogumil Engel, a local master clothmaker, 67 years old.