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

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©Is MIHW1IS,
[To be returned to the Circuit Clerk of the County in which the Birth occurs.]
1.	Month, day and year of Birth,....................................- /htA..
,f. Sex, .... ^	A\	•.............................:.....: .............
o.
Colo?
Jf. Stcde if still-born, ...
5. Fall name of Father, ...j,
5.	Name of	Mother previous	to	marriage,..
7.	Nativity	of Father, ..................................fib'll?....
S.	Nativity	of Mother, .......
T hereby	certify that	the	above is	a	true return of	the	Birth and other
facts above recorded.
Dated at ...... ...............................
County of....*&ihk&fr..^	.....,Miss., ■ .....
liiis.../j 77- diuy of\.M//^t^...IShd- J
Residence
Htending Physician.
*
* State whether White, IUaclc, Mulatto, Indian or other Races,
f Strike out these words if the Return be made by some other person, and add other explanatory words.