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

---

I

/*
State Board of Heatth '
fr/§VD#£R3C)0Ucbt^ #3!T
istrar’s Record of Births^
Prtiinfv' rt-f
££>_ County of
State of Mississippi
...../f‘/x
1
Registrar’s Register No..
Born In
Voting Precinct
or Village.
(Hospital)______
Date of Birth
Full Name of Child-
or City.
Sex.
Full Name of Father
.am.;
f !	OcPJb^'. f /!'
-F
Color.
.Legitimate?
Mother’s *■, Maiden Ni
Full P. Address.
? y^»
fiQ<u£t,'7	__
Wame	.	<^’-^cCZTZ	^
/Say/
Born Alive?
Name and A of Attendan
Date Certif. Filed
Date mailed to / State Department I or Co. H. Officer
or Stillborn?.
O
J*
-VO&Z
.19£4
Registrar
Address.
Born In
Voting Precinct, or Village, or City. (Hospital)_________
Registrar’s Register No.
Z&JL
Date of Birth
Full Name of Child.
Sex.
/ /<r~
AM-^i ..PM.
.Color.
. Legitimate
Full Name of Father.
^gyt£. vS
ImateJ^^a.
Mother’s Full Maiden Name
S_
Full P. Address
Bom Alive?.
Name and Adi of Attendant
"Date Certif. Fill
Date mailed to State Department or Co. H. Office
Registrar.
Address
.or Stillborn?.