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It has not been edited and may therefore contain several errors.

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auiiwus.
[To be returned to the Circuit Clerk of the County in which the Birth occurs.]
1. Month, clay and
year of Birth,,  /i~4^ tj’jz...
Sex,	?	...
s. color, * y^-'A'z 'Az
Jf. State if still-born,
5. Fullname of Father,	............. ................
5. Name of Mother previous to marriage,....................................................
7. Nativity of Father,	 ..................(2f£....££>.....*.....
8.	Nativity of Mother, ..................................................................
1 hereby certify that the above is a true return of the Birth and other
facts above recorded.
Dated at	...............
County of.	........, Miss., •
lhis..,/f?......day of^^t^t^..,..........18%O. J
Residence.....................
t~Attending Physician.
* State whether White, Black, Mulatto, Indian or other Races.
f Strike out these words if the Return be made by some other person, and add other explanatory words.