This text was obtained via automated optical character recognition.
It has not been edited and may therefore contain several errors.

---

ft
State Board of Health
* tf( ^ Jb tfr/T
Registrar’s Record of Births
County of

/ , ,/•	^	^	State	of	Mississippi
1	/	tf/S	VA	/ft?/?,* ?
Born In
Voting Precinct f,1 or Village______________
Registrar’s Register No..
2£_
or nit? >)	^
"i • _________________________________
(Hospital)______________ 1'L_______'*'/	---------------------
,	/.	"W,	T
Date of wtrth	/Y______19^/	—A.M----------_P.M.
Pull Name	J
Of fihllri	 JL
(-1	V.
Sex.
Jj£l
/<■' 'j 'v
Color
_ Legitimate ? 4/
• - >	'
Pull Name y	j:	,	/.I	>	/	,
Mother’s Pull	'	*	i/s
Malden Name	/p[
Full P. O.
Born Alive?.
_or Stillborn?.
Name and Address^ .	/	7*~/	tj	_	_	, /
Of Attendant	C-6-'	£-<-
Date Certif. Filed	$f.	/ // Y
Date mailed to	it,'/
State Department	J? t
or Co. H. Officer '	1	—uL±-
.lflVZ
,19j£?
•? <.*■
A.' •
Registrar.
Address	■-'r .f' L L "
Bom In
Voting Precinct /rr / or Village_________________
Registrar’s Register No.
7 3
or City. (Hospital) __________(..
23 OsC't </sf~
Date of Birth /S.	fn IQ Vf ^ A wJo ~^p.M.
■5“ cmT	?y	^	^
J/Z/X ff________Color _Z^Z__
Sex
Full Name of Father.
Mother’s Pull > 1
rr^i4^ d. t___
Maiden Name //M^«-/
&
(fit >L
Bom Alive?.
y
_or Stillborn?.
^oT’Attend^y^o ^ j/(p £7. /3oa3°/
Date Certif. Filed.
Date mailed to State or Co.
z	/%______________i*Y_[
Registrar.
Address.
laucu WJ	/	*	\
Department /'.s' -/ J j 0. H. Officer L^' A^ z	/	/
-ViJSLf
7- v_