The form is bilingual, in German and Polish. I only translate the German parts, I guess the Polish parts of the form will be the same. The header reads. I try to decipher the handwriting, and indicate where I am not sure.
- [day missing]
- "Jänner" (austrian for "January")
- "1885"
- "Jassien" [This could refer to one of the several places currently named Jasień, some of which are in the formerly Austrian part of southern Poland]
- "60"
and these lines are repeated:
- "23"
- "Jänner"
- "1885"
- XXX
- "60" (this is the street/house number: the correspondent column reads [Hau]"s-Nr." / "Nr. domu")
The column entries read:
- Name of the child ["Name des Kindes"]: Isaak
- Sex ["Geschlecht des Kindes"]: male ["männlich"]
- Legitmate, allegedly legitimate or illegitimate birth ["Eheliche, angeblich eheliche oder uneheliche Geburt"]: illegitimate ["unehelich", i.e. the parents have not been married]
- First and last name of the father, marital status, profession and city of living ["Vor- und Zuname des Vaters, sowie Stand, Beschäftigung und Wohnort"]: Efraim Samuel Epstein, not-married ["ledig"], innkeeper ["Schenker"] in XXX, where XXX is the same town as the place of birth of the child.
The titles of the first two large columns are largely missing, but it's safe to assume that the first one records the birth date and the second one the date of inscription in the birth registry (or possibly, if the page is from a church register, the date of baptism).
