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Registrar’s Record of Births County of
State Board of Health	~	State	of	Mississippi
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Registrar’s Register No._ S.A.
Born In
Voting Precinct—’1s£.	-----------
or Village.
or City (Hospital)
Date of Birth
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t
Sex
PvUl Name A / of gather frxt
Mother’s Pull jr Maiden Name
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Born Alive V
Name
erf A
4dL
L,____of Stillborn?,____
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Date Certif. Piled
Date mailed to State Department
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r. i
Registrar
MUM.
Address	4P*	,lL
T
Registrar’s Register No,____
Barn In
Voting Preclnct^^/	^r,ft_______________
or Village______________________________________
or City-
(Hospital),„■ ,	,	____y C-'<^~-Ss •
Date of Birth-Full
IB&a.
? chS** Hi. 0	LIt	All IA i'r^X
se*,
P\iU Nam< of Fathe
.Color	-V	Legitimate?
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^Addresf'j) 2 j	______________
Mother’s Full Malden Name
Bom Ajivef.
____or Stillborn?.
Name and AddreasW", -tf ■• /	y
of Utendant Yl'W* £ js,
___j2_
Date Certif. Piled.
Date mailed to
State Department
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