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State Board of
Registrar’s Record of Births
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State of Mississippi
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Bom In
Voting Precinct-or Village, or City_ (Hospital)_________
Registrar’s Register No.
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Date of Birt]
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Full Name 'Zf	yfrf-' 'ZJif ^
of Child//
Color_ . vy.	. Legitimate ? f~\
Sex
Full Name of Father.
Mother’s
Malden
Born In
Voting Precinct-or Village, or City_ (Hospital)__________
Registrar’s Register No
Date of Birth.
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_AM.
Full Name of Child_
Sex
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- Legitimate^____
Legitimate?
Full P. O	,	C	y
Address U O -6J^
Born Alive?
Name and Addri of Attendant
Address
Date Certif. Filed
Date mailed to State Department or Co. H. Officer.
Registrar