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Registrar’s Record of Births /3.
State Board of Health
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County of
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State of Mississippi
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Voting Precinct, or Village.
Registrar’s Register No..
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ot City,
(Hospital).
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Date of Birth
Full Name of Child.
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Full Name of Father
Mother
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Address /Q/ (P-tX-^X. <3C^V-vl.
Born Allve?_
Name and Address of Attendant____
_or Stillborn?,
Date Certif. Filed____
Date mailed to State Department or Co. H. Officer.
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Address
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Born In
Voting Precinct.
Registrar’s Register No-
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or Village________
or City /(*) (Hospital)
Date of Birth
Full Name of Child.
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Sex_____.
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Name and Addri of Attendant
Date Certif. Filed.
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Date mailed to State Department or Co. H. Officer.
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