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State Board of Health
Registrar’s Record of Births
County of
State of Mississippi
Born In
Voting Precinct .
or Village.
or City_
(Hospital)
Date of Birth Full Name
Registrar’s Register No._
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A.M./zaLp.M.
Born In Voting Precinct
or Village.
Registrar’s Register No>
or City_
(Hospital)____________________u. <2£L
Full Name	//'	v	/!	^
of Child	/y^Vvt^e/	I
Sex _	_Color	L.I
x^ui
Legitimate
Full Name )	/	■	*	i
of Father x
Mother’s Full	/
Malden Name jo . xTVt/ //
Address ./C-Xy? Q.\J<^j	.
Born Alive ?_
X?
_or Stillborn?.
Name and Addr 4,	•	/	r/
of Attendant	Co
Date Certif. Piled.
Date mailed to State Department or Co. H. Officer.
o
19,1 f
.wJLz
Registrar.
Adtlitim*-Uv /* '<■ Z.j
J
\QA.f______-A.M./^ P.M.
Date of Birth
Full Name of Chili
Sex	•&'£&-	!y
QfyLiTs IulX
Color
Legitimate?
Full Name of Father.
h,yjLuL_
Mother’s Pull Maiden Name
JPull P. O. / \ Address / O'
Born Alive?
Name and Addri of Attendant
Date Certif. Filed.
Date mailed to State Department
y/.„, ,fc,
"" V/JIA '
or Co. H. Officer
Registrar.
SJ_
, t	,	y	.
Address	7.	t-V " ^	*>___