This text was obtained via automated optical character recognition.
It has not been edited and may therefore contain several errors.

---

KW*
Registrar’s Record of Births
'	%	jc	U*	County	of	,
State Board of Health	State	of	Mississippi
H~/s 33	/TW/fsff	H / rS. ■$ £ H f~R 5 ~A
Bom In
Voting Precinct, or Village, or City. (Hospital)_________
Registrar’s Register No_	7
isnZ'A________________________
Date of Birth,
air 6
19^3
, A.M.
¥ P.M.
oxrnsm A
Color or -Legitimate?-of Fath txS<2yl41*slj£	C^Tyl^i^i	aj<>\	f
Full Name of Child
Sex
Mother’s Full Maiden Nami
Full P. O. Address ^3
Bom Alive?_
Name and Adi of Attendant
_or Stillborn?-
Date Certif. Filed Date
)ate mailed to	~~T^/
State Department f / / ‘J or Co. H. Offipjr LA: -OL / ^
-19 -$L3> .19_^-J>
IU^UUM'
Address.
‘.i/7
~!W
t mv'ivww .■-v www»».iw yi>ni. uwujvji-'^i.wwy ■