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State Board of Health
Registrar’s Record of Births
County of
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State of Mississippi
Born In
Voting Precinct
Registrar's Register No..
JUL
or Village________
or City _££}_ (Hospital)
Born In
Voting Precinct, or Village.
Registrar’s Register No. *4$__________________________
AA.
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Date of Birth
Full Name of Child
Full Name of Father
or nn.y (Hospital)_
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PM. Date of Birth
Full Name, of Child//
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.Color.
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Legitimate ? ^-<-g OsU4-~<
Sex
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^Maiden Narii^J^^	J$Zc>s&s£a
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Full Name of Father
Mother’s Full : / Maiden Namel^AcU
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Legitimate?.
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Full P, Address
Born Alive?.
Name and Adi of Attendant
.or Stillborn?.
Full P. O. Address _
Born Alive?.
Ox.
_or Stillborn?.
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Date Certif. Filed /V Date mailed to
&JL__________19MD
Name and Addri of Attendant^
Date Certif. Filed.
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Jate mailed to	t/\	^
State Department J(/,	/	/\	,	fJ.
or Co. H. Officer	/	1(1 Up
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Date mailed to / ^
State Department J .	s
or Co. H. Officer
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Registrar
Address
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Registrar.
Address