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 Cleric of the County in which the Birth occurs.]
1.	Month, day and year of Birth,......................................... .//£*_
2.	Sex,..........................................„................................
8.	Color, *................................. .....................................
Jf. State if still-born, ...-	...............................................
5. Full name of Father,  %
5. jVame of Mother previous to marriage,..	........
7.	Nativity of Father,.............................................................
8.	Nativity of Mother, ................................ ............................
1 hereby certify that the above is a true return of the Birth and other
fads above recorded.
Dated at _................................... ) /yf /->,	~T\
7,^	..................................,
County o f.......................,Miss., /	//	,	,m	■	■■
■	/j^/7	1	//	T	-dMeiimnti'-I	yn/sicicm
this../%.....day ofJ^fyZ:........18%a. J /
liesidence..................................
*	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.
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