"Registration of Birth and Color," State of Virginia form
Pages:1 of 1
University of Albany, SUNY, Estabrook, SPE,XMS 80.9 Bx 1
View this image in our new website.
&quote;Registration of Birth and Color,&quote; State of Virginia form

REGISTRATION OF BIRTH AND COLOR Full name[dashed line](Give name first. Give full maiden name if married woman or widow.) Place of birth[dashed line]sex[dashed line] Date of Birth Name of Husband[dashed line](If married woman or widow) Father Full name [dashed line] Birth place [dashed line] *Color[dashed line] Mother Full maiden name [dashed line] Birth place [dashed line] *Color [dashed line] Remarks: *A white person is one with no trace whatsoever of blood of another race, except that one with one-sixteenth of the blood of the American Indian, unmixed with another race, may be classed as white. Form 59-3-17-24-65M. I hereby affirm that I believe the statements as to color of parents on the other side of this card are correct and that I am signing this with the knowledge that the penalty for making a false statement as to color is one year in the penitentiary. Signature of registrant [dashed line] Address of registrant [dashed line] Witness to signature [dashed line] Address of witness [dashed line] *Signature of physician [dashed line] If not signed by registrant state kinship of signer [dashed line] Place of filing [dashed line] Date of filing [dashed line] If the person signing the statement cannot write, he or she must make a mark between the given name and the last name, Thus his (her) *If the doctor present at birth signs, it will be accepted as to age for labor, school, etc. John X Doe Mark [end]

Copyright 1999-2004: Cold Spring Harbor Laboratory; American Philosophical Society; Truman State University; Rockefeller Archive Center/Rockefeller University; University of Albany, State University of New York; National Park Service, Statue of Liberty National Monument; University College, London; International Center of Photography; Archiv zur Geschichte der Max-Planck-Gesellschaft, Berlin-Dahlem; and Special Collections, University of Tennessee, Knoxville.
The images and text in this Archive are solely for educational and scholarly uses. The materials may be used in digital or print form in reports, research, and other projects that are not offered for sale. Materials in this archive may not be used in digital or print form by organizations or commercial concerns, except with express permission.