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State Board of Health
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Registrar’s Record of Births
County of	$' H-
,	State of Mississippi
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Born In
Registrar’s Register No..
Voting Precinct-
or Village___________________________
or Cltv (Hospital)____________
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Date of Birth
Pull Name of Child
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Sex
Pull Name
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Legitimate
of Father.
Mother
Maiden
Full P. Address
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Born Alive?
Name and Addles	ft
of Attendant l/rx^i ^ O
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Date Certif. Filed.
Date mailed to State Department or Co. H. Officer_____L
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Ragtotrnr
Address-
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Bora In
Voting Precinct _
Registrar’s Register No. /ff
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Full Name of Child-
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Sex.
Full Name of Father.
. Legitimate^-
Mother’s Full Maiden Name
Address <- J O
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Bom Alive? Name
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.or Stillborn?.
(Tame and Addresser	)	0
Of Attendant /Cg	/-■<*	sC	^TT?
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Date Certif. Filed____
Date mailed to State Department or Co. H. Officer.
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Registrar.
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