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Registrar's Kecord ol liirtns
County of
State Board of Health
State of Mississippi
Born In
Voting Precinct
Registrar’s Register No,
*-U-
or Village.
(Hospital)
Date of Birth
Full Name of Child__________
or City,
AM yo P.M.
.Color.
.Legitimate?.
Pull Name of Father.
Mother’s Pull Malden Name.
Full P. O. Address___________
Born Allve?_
_or Stillborn?.
Name and Address of Attendant________
Date Certif. Filed.
_19_
Date mailed to State Department or Co. H. Offlcer_
-19-
Reglstrar. Address -
Bom In
Voting Precinct, or Village.
Registrar’s Register No_ : -j ‘ ' r fred'X
(Hospital)
or City.
X.
Date of Birth.Xc-c. ^ A £ % ia ^ ft________________________A.M. (D P.M.
Full Name //'"
'‘ull Name //" ,[7 <L	C
of Child	-6
7 t,y	Color
i
Sex
Full Name of Father.
Color i/.O CiaA x_ Legitimate?
JLq_
t/
Mother’s Full Malden Name
Full P. O. Address
Name and Address f/t of Attendant
wCo €	— o^\ Xg