sample birth certificate - see original that I made in class... this is just to give you an idea

Missouri Department of Health Bureau of Vital Records

P.O. Box 570

Jefferson City, MO 65102-0570

Certification of Live Birth

This certifies that James Mercer Langston Hughes was born in Joplin, Missouri on February 1, 1902 .


Carrie Langston Hughes James Nathaniel Hughes
Mother Father

Weight: __ lbs __oz
Length: __ inches
Official Seal of Missouri

______________________ _______________________
Delivering doctor date Witness date

Official Seal of Missoui