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State Board of Health
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Registrar’s Record of Births
County of
State of Mississippi
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Born In
Voting Precinct
or Village or City (Hospital) _
Registrar's Register No._
	
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Date ol Birth_______-6___________________19_i,'
Full Name " ^.' of Child / '■( ■ .
Sex •'	’	f	■'	-	•-	_____Color
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Full Name /	’	-	>	/	'	t-X
of Father'/.. "■£	/>'	A;	>	■	r.	c,
Mother’s Full Maiden Name.
Full P. O. r' Address t
V" jf 'I ■' \S fJ / ' S. ■ rri > /i
Born Alive?.
Name and Address . ,	/y	/
Of Attendant ' S .r'i'i'-Q	7	1/	^__1<-
.or Stillborn?.
T
Date Certif. Filed.
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Date mailed to State Department ^ or Co. H. Officer_______
._ux
Registrar ( Address.
19./ ’> .19 Jj?
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Born In
Voting Precinct
Registrar’s Register No-c"f'\________________________
or Village, or City. (Hospital)_________
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X ’----------------------- <_______________L.
Date of Birth	ifl	.3 ° / 'am________________pjyi.
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Full Name /-' ■/	^	^
Of Child.jSJ	i	Asr/i //i ! <7---
Sex ^ >4n a-t t Color	^ T^glHmnt.p? ,^-i
/
*	-7/	>d_.
Full Name , fJ- „	,
of Father .'’7/
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Mother’s Full	,v
Maiden Name ’■»-■	-	<-
Bom Alive?.
_or Stillborn?.
Name and Address i . , of Attendant	o	u
V
o
Date Certif. Filed	______________19^2_?
Date mailed to
State Department V /'y1—	^	/	,
or Co. H. Offlr^r	^	-
Registrar.
Address .
r/’' i/ ,/y
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.19_l2J?
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