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Registrar’s Record of Births
jf& c^£Pj' j	County	of	^	^
State Board of Health	,	State	of	Mississippi
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Born In
Voting Precinct
or Village, or City. (Hospital)_________
Registrar’s Register No.
4t
Id
Date of Birth
Full Name of Child
Sex
Full Name of Father
/t*6 A-M.//? ~TTm.
Mother1
Maiden
Full Address
5La jo 3 if	X
Born Alive?_
Name and Addre of Attendant.
_or Stillborn?
V<ZsC
Date Certif. Filed.
_19_
Date mailed to State Department or On, II. Offlner
Born In
Voting Precinct, or Village, or City-(Hospital)__________
Registrar’s Register No. A?
,4i------«, rrA-----------
$¥J ______________________
Date of Birth /2*i.
4L.	j________________
.PM.
Full Name, of ChUdJ^t
Sex.
.Color
Full Name of Father
Mother’s
Maiden
9r~ _ Legitimate^JlsLH-
../r 'L,	t--------------
as.
Full P. O. Address _
2l
Bora Alive ?_
_or Stillborn?,
Name and Address of Attendant________
Date Certif. Filed-
-19-
Date mailed to State Department nr On, H, Officer