This text was obtained via automated optical character recognition.
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.]
1.	Month, day and year of Birth,
2.	Sex, .	...............................................................—
3.	Color, *......................;.................................................
Jf. State if still-born, ...	.................... ......................:.........
5. Fall name of Father, ...	...............................
5. Name of Mother previous to marriage,. _________.................................
7.	Nativity of Father,	.....y^&d*?...!.......................
8.	Nativity of Mother,	..'/...........................
I hereby certify that the above is a true return of the Birth and other
facts above recorded.
Dated at.............................	... ]
County of 'Mw-/^Z)................, Miss., > .......777
this..c?f7? ,..day of...$.&&ih^c:..../8 7^. J
Residence...c\	....
* State whether White, Black, Mulatto, Indian or oilier Races.
f Strike out these words if the Return be made by some other person, and add other explanatory words.