This text was obtained via automated optical character recognition.
It has not been edited and may therefore contain several errors.

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[To be returned to the Circuit Clerk of the County in which the Birth occurs.]
/. Month, day and yea?' of Birth, . //...Ss/.... ..,  ///>'  
2. Sex,	z
3.	Color, *
Jf. State if still-born,
5. Full name of Father,
5. Name of Mother previous to marriage/...
7.	", Nativity of F
8.	Nativity of Mother, ......______________________________
I hereby certify that the above is a true return of the Birth and other
facts above recorded.
.Dated at	-■*.*.	....
County of....dsC,..................., Miss.,
 day of	 .18 7jy. J
Residence
this...
* State whether White, Black, Mulatto, Indian or other Races.
f Strike out these words if the Return be made by some other person, and add other explanatory words.