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State Board of Health
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Registrar’s Record of Births
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SJate of Mississippi
Born In
Voting Precinct
or Village _________
or City. Mu (Hospital)_________
Registrar’s Register No._
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Full
pull Name /P) of chiiri y
Sex.
.Color.
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.Legitimate?.
Full Name of Father;
Mother’s Full	—.	/O'
Maiden Namei"~j /	<g?-
Full P. O. Address_____
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Born Alive?.
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or Stillborn?.
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Name and Address v V of Attendant —jLj2 -
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Date Certif. Filed.
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Date mailed to State Department or Co. H. Officer-
Registrar.
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Addrnsfl —
Born In
Voting Precinct, or Village, or City. (Hospital)_
Registrar’s Register No_____S *3 3
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Date of Birth.
Full Name of Child
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Sex
Full Name of Father
Color.
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Mother’s Full Maiden Name
Bom Alive?
Name and Ad-of Attendant
Date Certif. Filed
Date mailed to State Department or Co. H. Officer.
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