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

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H.H©ISKAWI®Sf ©Is 3§!Jl*i®»»
[To be returned to the Circuit Clerk of the County in which the Iiirth occurs.]
1.	Month, day.,and year of Birth,
2.	Sex,	HteL-...
S. Color,
Jf. State if stillborn,   
6) o
s'
5. Full name .<?/ Father, Spfytttev...........................................
5. Name of Mother previous to
7.	Nativity of Father,	..>
S. Nativity of Mother,	....................................
I hereby certify that the above is a true return of the Birth and other facts above recorded.
Da,ted, at	.... ....... ")
County of..........................., Miss., \ ...
J ■ /f	v	’	1	//	T-rftj±EJmin&	FhymtfWbP.,.
this..	day	of\.M.^t^......18%d. J C
Residence ^ :*4JL.
* State whether White, Black, Mulatto, Indian or other llaces.
f Strike out these words if the Return be made by some other person, and add other explanatory words.