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Kegistrar's Kecord of Births
. County of
State Board of Health, ^
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tate of Mississippi
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Born In
Voting Precinct
Registrar’s Register No._
or Village.
(Hospital)
Date of Birt
Pull Name of Child
Sex
Pull Name (j,	<	O/l	/
of Father/f/3^<^ <L> (
Mother’s Pull	-Z7	O?	/
Malden Name (P//TlJ^H^*2	y-*-^	/
Pull P. O. >2 Address
Born Alive?
Name and Ad of Attendant
Date Certif. Filed
or Stillborn?.
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Date mailed to State Department or..Co. H. Officer^
Registrar.
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V&1
Address -
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Voting Precinct /ff
Registrar's Register No -ZJLA,
or Village, or City. (Hospital)
Date of Birth
Full Name of Child-
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Sex
Full Name of Father
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Color.
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-Legitimate?
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Mother’s Maidenl'Name
Full P. O. Address.
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Bom Alive?.
Name and Addri of Attendant
D^te Certif. Piled
Date mailed to State Department or* Co. H. Officer
Registrar.
Address
.or Stillborn?.
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