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Registrar’s Record of Births ~ 2^^^- County of , fa'
State Board of Health	*
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State of Mississippi
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Voting Precinct-or Village.
Registrar’s Register No._
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or City,
(Hospital)
Date of Birth
Pull Name of Child
Sex
Pull Name of Father
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Born In
Voting Prec:
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Registrar’s Register No_ inrK-	g^X----------
or • Village________________________________________________
or City______'¥\J
(Hospital)_________
Mother’s
Malden
Full P. Address
Born Alive ?_
Name and Adi of Attendant
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_or Stillborn?,
Date Certif. Filed,
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Date mailed to State Department or Co. H. Officer-
.19-
Registrar.
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Date of Birth
FuU Name1 of Child
Sex
FuU Name of Father
Mother’s FuU Maiden Nami
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. Legitimate
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FuU P. Address
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Name and Ad of Attendant
or StUlbom?_
Date Certif. FUed.
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Date maUed to State Department or Co. H. Off leer _
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Registrar,
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