No. 37, Nowa Wieś, February 18, 1927
The Commissariat of the Silesian Voivodeship Police in Nowa Wieś reports that the miner Ludwik Rzepa, born on August 6, 1889, in Żydowo (or Żydów ?), of Roman Catholic faith, residing in Nowa Wieś, 3 Maja Street No. 19, married to Stanisława née Śrama, residing in Nowa Wieś, passed away in Nowa Wieś, at the Hilebrandt mine (note: should be Hildebrand), on February 13, 1927.
In the text, 26 printed words were crossed out.
On behalf of Civil Status Officer,
Tichner
(penciled note: 6 children, 15 years of marriage, no property, accidental death)
Rado