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7
State Board of Health
ft IS Hfc R	£
Registrar’s Record of Births
^ County of /t&L
Jl
State of Mississippi
is
Registrar’s Register No._
Born In
Voting Precinct
or Village, or Clty_ (Hospital)_________
/&?- if"
Bom In
Voting Precinct
or Village________________________
or City_
(Hospital)
Registrar's Register No.
-2-2-
xr~PA-
Date of Birth
Pull Name of Child
Sex
IbV^? 6 A.M.
_P.M.
Date of Birth
^ 9fj>
Pull Name of Child.
A.M.-
.P.M.
tynaJLg.
Legitimate
FuU Name of Father.
Sex.
TS-
.Color
. Legitimate
Full Name Of Father
Mother’s Full Malden Name
Full P. O. Address
Born AUve?_
Mother’s Full Maiden Name.
FuU P. Address
Name and Addri of Attendant
_or StlUbom ?_
isf'’ ^2^%^d^ nr stlmjom?
Date Certif. FUed
Date mailed to State Department or Co. Officer
RflgUtiftr.-Address _
~fp
Bom AUve?.
Name and Addre; of Attendant
Date Certif. FUed
Registrar.
Address-
Date maUed to State Department or Co. H. Officer
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