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State Board of Health
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Registrar’s Record of Births
County of
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State of Mississippi
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Voting Precinct
Registrar’s Register No..
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or Village_________
or Cltv / 0 > (Hospital)_____________
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Date of Birth
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Voting Precinct, or Village, or City. (Hospital)_________
Registrar’s Register No_
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Date of Birth
Full Name of Child
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Full P Address
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Born Alive?
Name and Addri of Attendant
Lot Stillborn?.
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Date Certif. Filed
Date mailed to State Department or Co. H. Officer
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.or Stillborn?.
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Date Certif. Filed.	/sr
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Date mailed to State Department or Co. H. Officer.
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