Mayor's office Alt-Pfirt, county Altkirch, July 3, 1872, 6 am
Death certificate of Catharina Adath, age 84 years, died in Alt-Pfirt July 3 1872 at 5 am, status no profession, born in Hasenbourg (probably Hazembourg, in German Hassenburg), departement ???, residing in Alt-Pfirt, whose parents are unknown, widow of Moritz Blind, deceased in Levoncourt.
The above mentioned declaration which was made before me by Franz Joseph Hartmann, age 49, status: teacher, residing in Alt-Pfirt, who declared he is not related to the deceased, and by Johannes Petitjean, age 50, status: painter, residing in Alt-Pfirt, who declared he is not related to the deceased, was undersigned after having been read by Franz Joseph Hartmann and Johannes Petitjean.
So executed before me, Martin Blind, mayor, in my capacity as civil registrar, after I have ascertained the death in the home.