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~	//	^e^^s^rar	s Record of Births
^	County of	4/^
State Board of Health /*£*«/•	—	^'p-
f-(-/ ?lJ7) ff & /t. 2 S' & ^L/eUc^f y	__
State of Mississippi
Born In
Voting Precinct,
Registrar’s Register No.. n v
or Village.
or
(Hospital)
/Xt.
Date of Birth tyr?—______________19^#^ 7/ \m
*£<%
_PM.
Full Name of Child
Sex
Full Name of Fathei
Mother’s Full Malden Nam<
Full P. O. Address
Born Alive?
Name and Addri of Attendant
Date mailed to State Department or Co. H. Officer.
ll0t|Ull'RI'
Address.
Bora In
Voting Precinct.
Registrar’s Register No*.
/ d
Date of Birth
19^ .I/.t^AJS...
Full Name	0^ J
of child //7asiy	I o-Mj^a
Sex.
_ Color.
0~V—
Full Name of Father
Mother’s Full Malden Nami
Full P. O. Address.
Bom Alive?.
Name and Adi of Attendant
Date Certif. Filed.
L Legitimate ?
>___PT~u~a. dowc
^-•	^—'
_or Stillborn?,
19
Date mailed to State Department or Co. H. Officer
KouUlmr
19_£=2L
Address.