This text was obtained via automated optical character recognition.
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 Death Occurs.]
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1.	Date of Death,............... ................................................................, 187(JL-.
2.	Mil Name of Deceased,...................>...........
yfr	.i
3.	Sex, ........................................c......jJ.h.l^lsL...:............
Jf. Color*...................
■i
5.	Age, (last birthday),...............................?twi)...\jQ6VxA .......,........;.............■
6.	Nativity,.....................;......:....p:l;......fh'..ap cfl.^uld'..............................
7.' Occupalion,	  ^	r..*.’ \tj„ .//. : ...L.._
8.	Disease,....................................................................
1 hereby certify tha-t the above is ct, true return of the death and othei facts above recorded.	<■
Dated at
County 0f....J/MllC-zlL ........  Miss.\ ~ ;........f^ndinfk£SiaP
wunoi/y..................................JUM.,	T	Attending	Wcct	si
this ...........day of.if)jiHii........., 187Cj .)	'
Residence,..........
*	State whether White, Black, Mulatto, Indian or other Races.
f Strike out these words if the Return be made by some other person, and add other explanatory words.
♦ ’ ■■ . ' • i