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Registrar’s Record of Births ^	fit*- County of	'^‘7^
State Board of Health	„	State	of	Mississippi
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Born In
Voting Precinct	c
Registrar’s Register No.
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or Village, or City (Hospital)
Date of Birth,
Full Name^ of Child,
Sex
Full Name of Father
/J___IS //J\ M_______P.M.
_ Color.
.Legitimate?
Mother’s Full Malden Name 42.
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Address //jQ. /?J~ /3<>f7 7¥ tPa^c a (h
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Born Alive?	or	Stillborn'?
Name and Address of Attendant________
Date Certif. Filed.
ft
Date mAed to	~	,
State Department (l/fy a ^ A	n /
or Co. H. otflcer_ZZiAlCdk_______d I
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Registrar
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Born In Voting Precinct
or Village.
or City
(Hospital) _
Registrar’s Register No-
//7
Date of Birth	/	9	19^J	/>	^
AM..
.PM.
Full Name of Child.
Sex____
Full Name of Father
Mother’s Full Malden Name
Full P. O "/’ Address
Born Alive?
Name and A< of Attend!
or Stillborn?.
Date Certif. Filed,
2- i
.18
Date mailed to State Department or Co. H. Officer
1
Registrar /Y('/7
Addiena _
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