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

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[To be Returned to the Circuit Clerk of f the ..County in -which the Death Occurs.]
♦ ft *-
1. Date of Death,,.  ............................................. ...........1.8 %0~.
2. Full Name of Deceased,
3.	Sex,....................
Jf. Color*......^AtZjr.......
5.	Age, (last birthday),.
6.	Nativity,........................r^&?-
7.	Occupation,.....................................
8.	Disease,....
I hereby certify that the above is a true return of the death and other facts above recorded.
Dated at.................................	...}	^	,
County of.............................,.,Miss.,) ....^ fAUeMing 'PhysieiAn.
this...........day ofJoe-C^>......., 18%.&„
Residence, „....Z~-
* 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. >	,
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