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Registrar’s Record of Births
County of
State Board of Health
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Born In
Voting Precinct-or Village,
Registrar's Register No..
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(Hospital) -----------------1	71-
Date of Bli;th L'p/*-
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.P.M.
Pull Name// ' J	Q-
of Child
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■ -p- / *-- y _Color 'j - siyy C ^-Legitimate?	/•
Full Name of Father .£
Mother's Full Malden Nam
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Full P. O. ) ^
Address.
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Born Alive?.
Name and Address^/ / of Attendant......./.IS. .r _____i_<u
_or Stillborn?.
Date Certif. Filed______
Date mailed to State Department or Co. H. Officer.
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IUtgUlrar... Address ../ (.
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State of Mississippi
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Born In
Voting Precinct, or Village, or Clty. (Hospital)__________
41
Registrar’s Register No_
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Date of Birth.
Full Name of Child
7/3	/0 ... _AJM_____________P-M.
Sex,
9c (^tal
, Color	T^gltli
Full Name of Father
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Legitimate?-/
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Mother’s Full .2/ ' /	' / sy L/ /
Maiden Name't' f	A
Full P. O.	//'	.	.	/
Address ? J	K	C-
I ll/^.
Bom Alive ?_
_or Stillborn?-
Name and Address of Attendant
/
Date Certif. Filed-
Date mailed to State Department *or Co. H. Officer .
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Roglatrar________1 i .^-X_______________________
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Address _
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