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/jjL Registrar’s Record of Births
^ ^	County	of	6
State Board of Health ^	State of Mississippi
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Registrar’s Register No. Born In	«	<	,
Voting Precinct	£LsyisX^ t?
or Village or City (Hospital)
Date o£ Birth
Full Name of Child
Sex
Full Name of Father
Full P.
Address
Born Alive?
Name and Addri of Attendant
Date Certif. Filed
Date mailed to State Department or
e Department /j /	( ,1	■
Co. H. Officer.	----J-
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