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Registrar’s Record of Births
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County of
State Board of Health
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State of Mississippi
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Registrar’s Register No..
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Voting Precinct '*%/?ci-^i,c: ..
or Village________________________________
or City.
(Hospital)________________	-<f	t'/»
Date of Birth
Full Name /Z-! of Child j/
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Full Name /'] // //, of Father.
.Color
^Legitimate?
Mother
Maiden
Full P, Address
Born Alive?.
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sn Name •p-fc'j	A	u^	i-Ltr	>'.r^
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.or Stillborn?.
Name and Address /'// of Attendant
Date Certif. Filed	&<&-'•■
' / / Date mailed to /II	/	/
State Department or Co. H. nffirpr
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Born In
Voting Precinct, or Village, or City. (Hospital)__________
Registrar’s Register No_ .	•■I	C________
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Date of Birth
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Full Name of Child 1^0 -
Sex
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Full Name of Father
Mother’s Full Maiden Name'
Full, P. O. Address
Bom Alive?.
Name and Address./^-	Z?'	1	/?	>>'	</
, of Attendant
Date Certif. Filed
Date mailed to
Address