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registrars Kecord 01 iiirths
County of
State Board of Health
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State of Mississippi
Bom In
Voting Precinct-or Village, or City_ (Hospital)_________
Registrar’s Register No._
Ad
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Date of Rlrt.h	/ f	 A.M.
So. c C
fM-cv-Cc,
_P.M.
Full Name of Child A <?
Sex
Full Name ( of Father
.Color.
.Legitimate ? h
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Mother’s Full 1, y< Q / f 0	(l/y~ ty
Maiden Naml^U. yiA a*'<As( A YIaA/a
Full P. Address
Born Alive?.
_or Stillbom?-
Name and Address of Attendant_______
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Date Certif. Filed	19	3	S
Date mailed to State or Co.
Bom In
Voting Precinct-or Village, or City_ (Hospital)_________
Registrar’s Register No.
<*Y
-Ot.r~C
Date of Birth (QsAjU. J?5_19 j^r	ff.A M.,_P.M.
if.X
Full Name of Child
Sex	eJj-^
-Color.
^ruvt.
Legitimate
Full Name of Father.
'■d
Mother’s Full >/V	,	/■' «
Maiden Nama^^ y aJ-UZ._________Cf>iL4sC\^
KMXuL
Full P. O. Address_____
4
Bom Alive ?_
<~0
_or Stillborn?-
Name and of Attendant
Department 6	/	r-— '	~
0. H. Officer <1 r^LsC
Registrar ■Jl/'t- fc?
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Address.
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Date Certif. Piled (
Date mailed to State Department or
v.
e Department //*?	•
Co. H. Officer_____£-r < (
Registrar..
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Address
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