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Registrar’s Record of Births
State Board of Health
7
State of Mississippi
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Born In
Voting Precinct
or Village
(Hospital)
Date of Birth
Registrar's Register No._
_A.M.
_P.M.
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Sex.
fn,cJ-e _ Color
Full Name of Father
Mother’s Full Malden Nami
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Born Alive?
Name and Acl' of Attendan
Date Certif. Filed
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or StlUl
cXC
W >t &
Date mailed to State Department or Co. H. Officer-
ItouUtmi'
Address.
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Born In
Voting Precinct _
Registrar’s Register No.
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or Village_____
or City. jSl (Hospital)
Atr
Date of Birth	/tf_____19 ¥<£
_P.M.
Full Name of Chlld_
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Sex.
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_Color_
J2a2.
. Legitimate?
Full Name of Father
Mother1
Maiden
or Stillborn?.
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Bom Alive?
Name and Addre, of Attendant^
Date Certif. Filed.
Date mailed to State Department or Co. H. Officer
ItcgLstnu'
Address. ,/d.w	jg.