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Registrar’s Record of Births County of
State Board of Health	q U*	^	0	State	of	Mississippi
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Born In
Voting Precinct, or Village.
4-
Registrar’s Register No._
J
or Clty_ (Hospital)____
Date of
BlrttvJ-^^Z^vi X 19-i^ JL.
Full Name of Child
-A.M.,
_P.M.
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Sex	__	Color
Full Name i. of Father,^
Mother’s/ Full y** Malden' Name
Full P, Address
iSS X*//	*
Bom Allve?_
Name and Addri of Attendant
or Stillborn?______________
Date Certif. Filed Date mailed to
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State Department */	/t^7'—	/
or Co! H. Officer	/
Registrar.
JL
4-
Address
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Registrar’s Register No-
JJL
Bom In	//	j?
Voting Precinct	C^CK
or Village_________________________________
or City.
(Hospital)_____	'Ur	/,
Date of Birth
Full Name J/f	s'	/
of Child KX t?~t-1 /A
19 yd / ^A,M.
_P.M.
Sex
X)&/	Color
tc Legitimate
Full Name yy' '/’/ • ’	.//
of Father /;/	sfl------
A;
Mother’s Full S'l Maiden Name (.A
Full P. O. J Address
Bom Alive ?_
Name and Addri of Attendant
	
J
_or Stillborn?-
I
Date Certif. Filed.
Date mailed to State Department or Co. H. Officer
Registrar.
Address