In Zagnańsk on this day, 12 June 1948, at 9.00 a.m., I, Mieczysław Kaczor from the Citizens’ Militia Station in Samsonów, acting on the basis of the following: Article 20 of the provisions introducing the Code of Criminal Procedure, on the instruction of citizen Deputy Prosecutor from the Region of the Prosecutor’s Office of the District Court, issued on the basis of Article 20 of the provisions introducing the Code of Criminal Procedure, observing the formal requirements set forward in Articles 235–240, 258 and 259 of the Code of Criminal Procedure, with the participation of reporter Władysław Fedrycz, whom I informed of his obligation to attest to the conformity of the report with the actual course of the procedure by his own signature, have heard the person named below as a witness. The witness, having been advised of the right to refuse testimony for the reasons set forward in Article 104 of the Code of Criminal Procedure, and of the criminal liability for making false declarations, this pursuant to the provisions of Article 140 of the Penal Code, stated as follows:
| Name and surname | Jakub Kszysik |
| Parents’ names | Wawrzyniec and Ewa, née Klimek |
| Date and place of birth | 25 July 1893, Skorzeszyce |
| Religion | Roman Catholic |
| Occupation | farmer |
| Place of residence | Ćmińsk-Wyrowce, commune of Samsonów, district of Kielce |
| Relationship to the parties | none |
| As regards the present case, I | am aware of the following facts: I do not remember the day, |
but it was in the month of June 1943. German soldiers drove up to Ćmińsk, accompanied by gendarmes, and took the menfolk in order to assist them in a sweep operation against partisans. Having sent us forward, they walked a few steps behind, and told us that if they saw any partisans, they would start shooting. But on that day they only shot three laborers who were busy working in the forest, digging up peat: Franciszek Proboszcz, Kazimierz Nadolniak and Nowak from Oblęgorek, the other two from Kawęczyn, commune of Samsonów. During the operation the said Germans immediately caught these three men and executed them on the spot. The bodies were buried in the forest and the whole “sweep” came to an end; the Germans ordered us to return to our homes.
I know nothing more regarding the case. At this point the report was brought to a close and read out before being signed by the witness.