Czernowitz Birth Certificate – Translate?

From Shula Kinger:

Can someone translate this for me? Click on photo to enlarge.

Item #570 in the photo is what I’m interested in having translated along with the Gothic headings.

Thanks,
Shula Klinger

Picker2

Bildschirmfoto 2015-01-16 um 09.32.53Bildschirmfoto 2015-01-16 um 09.33.07