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Sta^e Board of Healtl
A0^ s/ Hjs*. /9
Registrar’s Record of Births
M?f County of ■//
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/2
A-t
,, State
/6d"-fA l¥&i 3 8
ississippi
y
Bora In
Voting Precinct—* or Village or
(Hospital)
*
Registrar's Itegjster No..
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Full Name ot Father
Mother’s Full —'&/9 j *	,
Maid eh Name	fa
Full P. O. j / cv-Address r6 f ?T
Data mailed to State Department or Co. B. Officer.
Registrar Address
Born In
Voting precinct
or Village, or fcjty-<ljospttal)____
Jl
kegiatirar’s Register No..
<fCpks&.
Date of Birth.
//f	.	z»C	^ Ji-s?
A-______—AM._____________________P.M.
Sex_	—Color—OTP.. Le^ittomteT
Full Name of Father.
frri-vc
^AddSsf' Iflf&sTr-d*
Sorb Alive?.
.or StillbOr^?..
Date Certif, Filed.
Date mailed to State Department or CO. B. Officer „
IfL
Registrar.
Address.