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Registrar’s Record of Births
County of
State Board of Health
I tlA. a. d
State of Mississippi
Born In
Voting Precinct .
Registrar’s Register No,.
/(
or Village_________
or City. (Hospital)___________
//
y./
Date of Birth
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Pull Name of Child _La
Sex.
Pull Name (j.	.
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Mother’s Pull ()j	CS
Maiden name /	A. CX.
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Full P. O. Address _
Born Alive?.
or Stillborn?.
Name and Adi of Attendant
Date Certif. Filed,
Date mailed to State Department or Co. H. Officer.
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Registrar’s Register No. Born In	^
Voting Precinct ■/^T_____________________________________
or Village.
or City. .A	■ I'f"9^ 'U
(Hospital)_________I'
Date of Birth f^)/.
of Child pj-Ln-t i-^A «-
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Sex
.Color.
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Full Name	/
of Father (,	?. tfL'iU')sv~ <A^ol- i-uy 
Mother’s PuU A1/ 1	'	-/*-//	Cf ' f
Maiden NameZ/^yx	(y i/lA^vuj oL*^.
^Addre’s.^'^^ ^	JT"	7^-^^
Bom Alive?.
.or Stillborn?.
Name and of Attendant
Date Certif. Piled_________c
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Date mailed to ^	,
State Department .■•/ S /' or Co. H. Officer	^
ltoulatrar
Address/rj
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