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Registrar’s Record of Births
County of
State Board of Health
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State of Mississippi
Born In
Voting Precinct-or Village, or Clty_ (Hospital).
Date of Birth
Full Name of Child (P< ^
Registrar’s Register No._
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Born In
Registrar’s Register No-Voting Prer.inct	____________
JUL
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Sex
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Legitimate?
Full Name of Father
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Mother’s Full Malden Nami
Full P. O. / Address *-
Born Alive?
Name and of Attendant
Date Certif. Filed.
Date mailed to State Department, or Co. H. Officer.
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is
A9l_£
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Addren
or Village.
or City ,/.d (Hospital)
Date of Birth	_AJM._____P.M.
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Full Name of Child
Sex Q'f/f & /-Q Color 9^7/ t/ft Legitimate? . \
Full Name */ '	’	/>	(]	/’	CS
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Mother’s Full . Malden Name.
Full P Address
Bom Alive?
Name and Address^ ,	S’	(/ /S*'' y	/?
Of Attendant SA/Z^<1 rf? £*3 .	<x... -A
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Registrar.
Adclrofut
Date Certif. Filed
Date mailed to State Departmen or Co. H. Officer
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