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Registrar’s Record of Births
County of
State Board of Health
lci\ 3.
State of Mississippi
Bom In
Voting Precinct—<
Registrar’s Register No. J
or Village__________:_____________________
or city ^ o~-' fc_c	)lL
(Hospital) Qjr—A
Registrar’s Register Nn. ~Jr Bom In	^
Voting Precinct	l	t	cl	<^-Jy_____________
fc-TUr*:
Date of Birth Full
•fC
_a.m.ZZ^Tp.m.
^ull Name	(l-f/	'	„	(/'	,	J1
of rihiiri //si. l / a rtf a. z <_ C—
Sex
Full Name of Father.
Mother’s Full Malden Name
Full P. O. Address
Born Alive?
m:g
c,n\ar/7./,ht^Li____Legitimate ? "j fi-<J
cv '	*
L-7^l-d
L
/ .SjsyL
or Stillborn?.
corn Alivev_______1 ^	_______ui Duiiuumt--------------------
Date Certlf. Filed.
Date mailed to State Department or Co. H. Officer.
19_
.19-
Registrar.
AildroM	/	f	\	<J;'/	•'	figr:
or Village.
or City. /3c,.-, ,IC^1-,
(Hospital).
Date of Birth,
P.M.
Pull Name of Child ' V
w<- .2	19^16_£JLa.M._
jr.c^Lkla.,\x
Sex.
t	Color
Full Name
i
of Father Lc. <^o{ o'l
Legitimate?_____
Mother’s Full ,-*'yr'	fP	/"	y—
Maiden Name 1-- '7 -tX _ Ji	i^C'a
Pull P. O
'•rni p. o. a,	/	/
Address /\) ■.). ■-- /	i
Qi'i
r
v
Born Alive?.
iA
.or Stillborn?.
Name and Address ,	-j /	/'
of Attendant	(2> y'^-C
lTTv7/-f-
■1^ ,^w
.19.
Date Certif. Filed	/	_______________ in j
Date mailed to is'
State Department or Co. H. Offlcer.
Reglstrar	^
Address	f	/	,1/	^"	^*- ^