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

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IlB©ISBAr»S®ff Off iii:
*
[To be returned to the Circuit Clerk of the County in which the Birth occurs.]
1.	Month, day and year of Birth,
2.	Sex,....
S. Color,* 
Jj.. State if still-born,....
5. Full name of Fat h er, .
5. Name of Mother previous to marriage,..
7. Nativity of Father,
8. Nativity of Mother,	t I hereby certify that the above is a true return of the Birth and other
facts above recorded.
Dated; at Co u n t y o f.
this..../.#./^.....day	J
Residence....................
.1.
* State whether White, Black, Mulatto, Indian or^'other Races.
-\ Strike out these words if the Return be made by some other person, and add other explanatory words.