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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90501363

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lola IreneDelong Sex Female

Date of Birth July 17, 1920 Place of Birth KemptCounty of Queens

Name of Father Clarence F. DeLong MAIDEN NAME of Mother Cora Emily Ford

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

Residence of Father when child was born Kempt, Queens Co. Present address of Father Upton, Maine, USA

Occupation of Father at Birth of child Cook Place of birth of Father Kempt, Queens Co.

Race English Name and present address of Physician in attendance at birth Dr. A. C. McLeod, Caledonia, Queens Co.

Signature of Applicant Mrs. Clarence DeLong Address of Applicant Kempt, Queens Co. Date 15 June 1939

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lola IreneDelong

Born at Kempt in the County of Queens

That Lola IreneDelong Whose Birth is sought to be registered was

born at Kempt Queens County on July 17, 1920

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

Being mother of the child and making application for the certificate of the child, these statements are therefore correct.

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