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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.]
1.	Month, day and year of .Birth.......
2.	Sex, . ..
8.	Color, ....../£
Jf. State if still-born,......... -
5. Fnil name of Father,
X"...///*
5. Name of Mother previous to^inarriage,...........¥</.
7. Nativity of Father,	<
8. Nativity of Mother,
I hereby certify that the above is a true return of the Birth and other
facts above recorded.
Fated at. County of. -this..y /7r
, Miss. , / ..18%0.
t Attending Physician.
lies iden cr„''... C>(^
* State whether White, Black, Mulatto, Indian or other Races.	1
f Strike out these words if the Return be made by some other person, and add other explanatory words.