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Registrar’s Record of Births
State Board of Health
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County of
State of Mississippi
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Registrar’s Register No._
Voting Precinct
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or Village______________________________________________________
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(Hospital)__________
Date of Birtfc
Full Name of Child-
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Sex
■fColor________________fyfbXl/L.. Legitimate?
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Full Name of Father
Mother's FuU Maiden Name.
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Address*' J-l ' ‘{\T~~	AX7
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Born AUve?_
Name and Adi of Attendant/5f^ts2.
Stillborn?.
Date Certif, Filed _
Date maUed to State Department or Co. H. Officer.
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Registrar
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Address.
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Voting Precinct, or Village, or City. (Hospital)________
Registrar’s Register No-
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Date of Birth.
19.
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FuU Name of Child_______
Sex _
.Color.
. Legitimate?.
FuU Name of Father.
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Mother’s FuU Malden Name.
FuU P. O. Address_____
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Name and Address of Attendant________
Date Certif. FUed.
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Date maUed to State Department or Co. H. Offlcer.
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Address-