From great grand daughter Laura Niephaus "The attached document reads: Nr.173 Moers, the 24th of May 1910
To the official signing this document came today personally known Mrs Josefine Baret, born Neumann, no profession, living in Meerbeck, Bismarckstraße 17 and reported, that her husband, the merchant Giovanni Battista Antonio Baret, 33 years and 5 month old, of catholic religion, living in Meerbeck, Bismarckstraße 17, born in Ombrena, parish of Tramonti di Sotto, County Udine in Italy, son of deceased Paolo Baret and his deceased wife Pazienza born Rugo, both at last living in Ombrena,
in Moers, Josefstr.14, on the 23rd of May in the year nineteen hundred and ten a.m. Nine o'clock died.
Read aloud (to her), accepted and signed Josefine Neumann. Registrar: Strombeck