Klementyna Chodkowska, daughter of Kacper Chodkowski and Aleksandra Milewska, died on 10 November 1867 in Umiemy, Ciechanów Powiat, Płock Gubernia, Vistula Land, Russian Empire. She was buried at the parish church in Zielona, Ciechanów Powiat, Płock Gubernia, Vistula Land, Russian Empire on 13 November 1867.
The Death and Burial Record of Klementyna Chodkowska – 1867
SOURCE: Parafia pw. św. Marcina (Zielona, Ciechanów Powiat, Płock Gubernia, Vistula Land, Russian Empire), “ Akta zgonów 1866-1869 [Records of Deaths 1866-1869],” folio 150 recto, entry 46, Klementyna Chodkowski, 13 Nov 1867; filmed as Kopie księg metrykalnych, 1808-1892; FHL INTL microfilm 1,979,913 Item 3.
Click on the image above to view a higher resolution image. Click on the link for a PDF copy of the Death and Burial Record of Klementyna Chodkowska. Translated from the Polish, the record reads:
No 46 Umiemy This happened in Zielona on the thirteenth day of November in the year one-thousand eight-hundred sixty-seven at the hour of ten in the morning. There appeared Antoni Milewski, thirty-five years of age, and Leon Wilkowski, thirty-two years of age, residing in Umiemy, and they stated that on the tenth day of November in this same year at the hour of ten in the morning, Klementyna Chodkowska died, four years of age, daughter of the married couple Kacper and Aleksandra Chodkowski. This document was read aloud to the declarants and was signed by Us; the declarants do not know how to write
   [signed] The Reverend [Józef] Rutowski, Head of the Parish of Krasne, maintaining the records of the Civil State
Klementyna Chodkowska was my 3rd cousin 3X removed.
Copyright © 2010 by Stephen J. Danko
As I read your post, I could not help but be taken back to my own Clementine —- and ponder the wonder of names.