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State Board of Health 6 ~kj
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Registrar’s Record of Births
County of . 6> ^
State of Mississippi
Born In
Voting Precinct^ <kL
Registrar’s Register No..
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or Village, or Citv ffy (Hospital)___________ixl^i
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Date ol Birth.
Full Nam' of Child
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of Father /Lo-rv^.^
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Sex
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Full P. 0. -) q Address _aL4-aC-
Born Alive?.
Name and Addr of Attendant
_or Stillborn?,
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Date Certif. FUed. r Jj £ 6-
Date maUed to State Department sa — Q / or Co. H. Officer
,1 O^L $
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Registrar
Addresa
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Registrar’s Register Wn / 0 J
or Village.
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Date of Birth
Full Name of Child_
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FuU P. O. Address
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Date Certif. FUed_
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Date maUed to State Department or Co. H. Officer.
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Registrar.
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