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State Board of Health ' A
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Registrar’s Record of Births
yj_ Q" County of
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State of Mississippi
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Registrar's Regis ter.No. _ Born In	y	■>	•	^
Voting Precinct ,'Y{ t, 1/Jsl/C-	-----
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Date of Birth_______________L_____19_^/_
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Spt —AJ'/ tlA-i-_____CaVn^kXl_______ Legitimate?
P.M.
Sex
Full Name
of FatheiOy QWOO
Mother’s Full Malden Name
Full P. O.
Address
Born Alive?
Name and Addri of Attendant
Date Certif. Filed
Date mailed to State Department or Co. H. Officer.
Ketflllr
Address
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19-
Bora In
Registrar’s Register No-
or Village
	
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(Hospital),
Date of Birth yJSa~'l C'd- / <f inV/ ^ AM____________________________P.M.
gull Name r X >/ O’ r\ v Hjf Child C	nC	c.-u-x.	^
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Sex 7^C /-H	Hnlnr	-JjlT'
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Full Name , , / t 1	;Ls
of Father t /Vty	jy'/ »
Legitimate ?
Mother’s Full /'	f	(
Maiden Name r/...- *>!■' i- L 3
-V
^Address^'
Bom Alive ?_
_or Stillborn?-
Name and of Attendant
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/'/'/ / y ^	iq^ /
Date Certif. Filed Date mailed to
State Department J //	X
or CO. H. Officer Vf ^I C^X.
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.19^21
Registrar.
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Address
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