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Registrar’s Record of Births	/o
County of
State Board of Health	'	State	of	Mississippi
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Born In
Voting Precinct.
Registrar’s Register No._
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or Village__________
or City ^0. (Hospital)
Date of Birth.
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.AM.J.___P.M.
Full Name of Child.
dut*-______
Sex.
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.Color.
Full Name of Father.
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Mother1 Maiden Name
Full P. O. Address.
£
Born Alive?.
no.-i	t£r
Name and Add of Attendant.
Date mailed to State Department or Co. H. Officer-
Bom In
Voting Precinct
or Village.
Registrar’s Register No_
J£l-
or City
(Hospital).
Date of Birt
Full Name of Child
Mo* <tr
W-£
Sex.
Full Name of Father
Mother’s Malden N&ne
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____P.M.
Color.
&ri
Legitimate
at£*jrj°.
Full P, Address