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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600273

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn GlennaSmith Sex Female

Date of Birth January 28, 1920 Place of Birth Pleasant RiverCounty of Queens

Name of Father Locke Gorden Smith MAIDEN NAME of Mother Jennie Flora Mosher

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

Residence of Father when child was born Pleasant River, Queens Co. Present address of Father North Brookfield, Queens Co.

Occupation of Father at Birth of child Farmer Place of birth of Father Pleasant River, Queens Co.

Race English Name and present address of Physician in attendance at birth Dr. J. B. March & Mrs. J. H. Smith

Signature of Applicant Locke G. Smith Address of Applicant North Brookfield, Queens Co. Date 27 December 1933

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn GlennaSmith

Born at Pleasant River in the County of Queens

That Evelyn GlennaSmith Whose Birth is sought to be registered was

born at Pleasant River Queens County on January 28, 1920

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

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