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State Board of Health
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Registrar’s Record of Births
County of
^tate of Mississippi
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Registrar’s Register No..
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Date of Birth
FuU Name of
Sex
FuU Name of Father
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Full P. Address
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Name and Adc of Attendant
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Date
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Date mailed to State Department or Co. H. Officer
Registrar
Address
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Date Certif. Fill
Date maUed to State Departmen or Co. H. Officer
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Registrar. Address
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