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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.]
1.	Month, day and year of I> irtli.,	...
2.	Sex,	..........................................
3.	Color, *...........................................................:..
Jf. State if still-born,.......................................
5. Full name, of Father,    
5. Name of Mother previous to marriage,............>> ^
7. Nativity of Father, f/'Z' tZO' •
8. Nativity of Mother,  2>r-isvs , 
I hereby certify that the above is a true return of the Birth and other
facts above recorded.
Dated at.................................... 1
County of  .........................,Miss., i  
this. day of.	 187^. J
Residence........................
* State whether White, Black, Mulatto, Indian or oLher Races.
f Strike out these words if the Return be made by some other person, and add other explanatory.words.