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Registrar’s Record of Births
b £L	County	of	.4 x
State Board of Health	State	of	Mississippi
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Registrar’s Register No..
Born In
Voting Precinct, or Village or City.
M-
(Hospital).
.19 HA.
A-M._Z^2p.m.
Legitimate?
Full Name of Father
Mother’s Full Malden Name
Full P. O. Address
Born Alive?
Name and Addri of Attendant
Date Certif. Filed
Date mailed to State Departm or Oo. II. Offloor
Registrar
Born In
Voting Precinct
Registrar's Register No.
SLl
or Village_______
or City /$ (Hospital)
Date of Birth
Full Name of Child_
Sex
Full Name of Father
Color
<x*-7-
Legitlmate?
Mother’s Full Maiden/Name
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Born Alive?
Name and Addri of Attendant
Date Certif. FUed.
r
or StUlbom?_
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Date maUed to State Department /‘W/ or Oo. II. Offionr-C.^
11
10
Registrar. Address, t