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State Board of Health
_________rl i i I
Registrar’s Record of Births
County of
State of Mississippi
Born In
Voting Precinct f/ tZjr^ylfL £l
Registrar’s Register No..
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c-?y&
or Village, or City. (Hospital).
Date of Birth. -O. 1st..	19-2uf -----A.M.
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-P.M.
Full Name of Child
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Sex.
.Color
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of Father*
Mother’s Full Maiden Name
.Legitimate?
Full P, Address
Born Alive?.
Name and Addri of Attendant
Xy
_or Stillborn?.
■■
Date Certif. Filed.
j2
Date mailed to State Department or Co. H. Officer.
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19 3 V
Registrar
rr/y
isSS-
Address.
Bora In
Registrar’s Register No.
Voting Precinct yf^
or Village______________________________
or City (Hospital)________
Date of Birth
Full Name
19i5“________A.M._/i2-P.M.
-*La^ ) O-^
Sex
Color.
t
Legitimate ?_^td=a*
Full Name ^ /->-.	;	*	C
Mother’s Full
of Father.
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ik
Maiden Name ^Address'*	,
Vr
Born Alive?
T
Name and AddressJf of Attendant
or Stillborn?.
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Date Certif. Filed.
Date mailed to State Department or Co. H. Officer J(LjZ-
Registrar.
J£
Address f