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.5?*? JWfrs ■',/ [To1 be returned to 'the.’OircUit Olpflfjof.the Ceiuijty i^jy.hich the Birth occurs.
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I hereby certify, that the above is a true^iUrn of the Birth dhcl other , facts above recorded.	...■:.	K	■'v	s	•	,
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Dated at IZZZj/i Co uritiy of ..^y/lL^Z.L this}
tyiy °fMiss,,, ^	^	^Attending -Physician,
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Residence...
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**State whether White, Black, Mulatto,.Indian or otheir Bacess	■	'	;.	:• ii<->!t
+ Strike out these tyords if the Return be made by some other persbfl/iiridJadd other explanatory words. .. /’
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