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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90501296

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy Jean AntionetteBelfield Sex Female

Date of Birth August 5, 1920 Place of Birth Hammonds PlainsCounty of Halifax

Name of Father Francis james Belfield MAIDEN NAME of Mother Jean Hilda Haverstock

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Hammond's Plains, Halifax Co. Present address of Father Port Williams, Kings Co.

Occupation of Father at Birth of child Farmer Place of birth of Father Birmingham, England

Race English Name and present address of Physician in attendance at birth Dr. Edward Blackadar

Signature of Applicant Mrs. Jean H. Belfield Address of Applicant Port Williams, Kings Co. Date 16 August 1940

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy Jean AntionetteBelfield

Born at Hammonds Plains in the County of Halifax

That Dorothy Jean AntionetteBelfield Whose Birth is sought to be registered was

born at Hammonds Plains Halifax County on August 5, 1920

My knowledge of the fact and date of such Birth is based on the following Circumstances:

Mother of the child

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