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It has not been edited and may therefore contain several errors.

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[To be returned to the Circuit Clerk.of the County in which the Birth occurs.]
7.	Month, clay and year of Birth,....
2.	Sex-, ..
...................:..........L
S. Color, *....../j’/n r %...............................
Jf. State if still-born, . .....
5. Full name of Father,  
5. Name of Mother previous to marriage,,.......................................
7.	Nativity of Father, .	..(£&£...>...................................
8.	Nativity of Mother, ..	/fr~2-<?£s.(T^a.,.......................
7 hereby certify that the above is a true return of the Birth and other
facts above recorded.
Dated, cut _	/^yt?..............
County of	.......} Miss.,
this o£p-, day of'.	 I8 7 ?. J
Residence
........,
t Attending Physician,
* State whether White, Black, Mulatto, Indian or oilier Races.
•[ Strike out these words if the Return be made by some other person, and add other explanatory words.