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It has not been edited and may therefore contain several errors.

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[To be Returned tp the Circuit Clerk', of j the'.County in which the Death Occurs.]
./. Date of. Deafh,\	*' ...  	............	 , 187^
2. > Jfitill Name of Deceased,	,
3.	Sex,	.............ji.....I...
\.' CoZo^*	.....J:..£......i..11..
5. Age, (last I dr t h cl ajj),	..
0. Nativity].....................................
7. Occupation,....
.	'	x	'/	V	,	’	'	;
5. Disease,	 fZ&^.Xr	.
1 hereby certify that the above is a true return of the death and other facts above recorded.
Dated at.	..............
County	......Miss.,
'day of....M.^........,., 187j?.
Residence,..............	*£&.....
this..
Attending Physician.
* State whether White, Black, Mulatto, Indian or other Races.	’	<
f Strike out these words if the Return be made by some;other ,person, and add other explanatory
words.