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State Board of Health
Registrar’s Record of Births
County of
State of Mississippi
Born In
Registrar’s Register No._
■/'r —-/f
Voting Precinct.
or Village___________________________________________
or Cltv	A-C
(Hospital).
Date of Birth.
-P.M.
Full Name of Child.
rv<r;„,.yv
Sex
//
Colo;
/- Legitimate ?
Full Name oI Father
X
./
2sV
Mother’s Full	(y	/	T~	’
Maiden Name	4.	f\	Cc^f	O^lA^l	c-
Full P. O. Ay Address */if
Born Alive?
Name and Address	j?
Of Attendant // Cs>_____________Y	L
Date Certif. Filed
Date mailed to State Department or Co. H. Officer
Registrar
/) a-y /<PC~• *
Addrcw -
Bom In
Registrar’s Register Nn /
Voting Precinct t*7/^	-e.
or Village_______________________________
or City C-(Hospital)__________
&.7~ Zr *
Date of Birth
O—J
/6'
.P.M.
Full Name of Child
Sex_
X
£J.
G\
cuisr~<^<-
Ad-cC-
.Color.
. Legitimate?
Full Name P / r •}c	^
Of Pftthpr///	Sn	<S\	(J?
Mother’s Full /2 i /I	Zt'
Maiden Name (£'<£'2	u	<k
'3
Full P. Address.
L^'tJ /	'ATah	Cr~+.cj GiV	J'C'
Bom Alive ?_
*>
Name and Address of Attendant.
____or Stillborn?_______
H 7, X /	/"
/■A__________G?
Date Certif. Filed.
Date mailed to State Department or Co. H. Officer.
M
111
.19.
i_v
Registrar.
Address-
mm