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Registrar’s Record of Births County of
State Board of Health	x	„
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State of Mississippi
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Born In
Voting Precljjct
Registrar's Register No..
SSL
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0t Village	______________,
or City.
(Hospital)_________,
Date of Birth	—----AJVI^^P.M.
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Born Aiiva?	_______(it Stillborn?—L
Name and Afjdres^// of Attendant ’/£ fazX.
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Date Certif. Filed	sZ-^i	____________ULJJf
Date mailed to	,
State Department hf	s'	s*	„	„
*r Co; H. Officer yt S	,	,-,.	r-----IsSx
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Registrar
Address -
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or Village
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of Birth	191?-----^.AM.2—PM.
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Date
Full Name at OhUdJU&U.
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Name ahd Address or Attendant.______yy<s
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or Attendant
Date certtf. WUkU JLA—i9i_?
Date milled to
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Registrar -J("7 fa.	^ ""	«-—* \	■	 -- 
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