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Registrar’s Record of Births /3	4,0
County of /o y
State Board of Health	Sta|e of Mississippi
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Date of Birth
Full Name of Child.
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Mother’s Full Maiden Name,
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Name and Addri of Attendant //'/^a-o
Date Certif. Filed
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Date of Birth
Full Name of Childs
Sex,
FuU Name of Fatheri
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