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I
State Board of Health
Registrar’s Record of Births
County of
State of Mississippi
r ttegixthir’s Register No. j Bo* In / Vnt.lnr Precinct ,			<* M^Qdf / Registrar's HeflRtpr Nn. . *t • a Bora In Votlnff Preoinet,
nr Village	or Village
hr City	nr Pity , <t^-> i
(HOfiplW1 ^	(Hospital) fc\~ 'W- «-*''* *—*	
Date « tolAh Q--i i 1 ^ ^ A M. PM	Date 6f fiirth ^ 19 7 m pm
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