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State Board of Health
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Registrar’s Record of Births
County of
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State of Mississippi
Born In
Voting Precinct or Village
or City M (Hospital)	/
Registrar’s Register No._ it __________________________
Date of Birth.
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Full Name f) ] of Child (T'ZLUsOOL.
Sex
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19
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.Color
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.Legitimate?
Full Name / of Father:
Mother’s _ Malden toame
Full P.
Address
Born Alive?
Name and Adi * of Attendant
.or Stillborn?.
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Date Certif. Filed.
Date mailed to
Btatfl Department ^-/ /	w
r____J'Jh:______Z.,i ft.
or Oo. 11. OHIoor..
Registrar ft/f' >'1.	s*
Address _
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Born In
Voting Precinct, or Village, or Clty. (Hospital)_____
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Registrar’s Register Nn.	/__
jt
Date of Birth
S
Full Name ' * of Child
Sex.
Full Name of Father.
Mother’s Full v Maiden Nami
Full P. O, Address
Bom Alive?
Name and Addri of Attendant
2_____	....	19i^_________A.M.^-f^P.M.
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Date Certif. Filed.
.19
Date mailed to Statfl Doportninnt or Co. II. Ofllccr.
.19
Reglstrar_
Address.