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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600715

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Stella ElizabethKeizer Sex Female

Date of Birth December 20, 1920 Place of Birth Gold RiverCounty of Lunenburg

Name of Father Elijah Keizer MAIDEN NAME of Mother Lottie Veinott

Residence of Father when child was born Gold River Present address of Father dead

Occupation of Father at Birth of child Mason Place of birth of Father Gold River

Race White Name and present address of Physician in attendance at birth midwife - Mrs. John Myra

Signature of Applicant Mrs. Lottie Keizer Address of Applicant Gold River Date December 27, 1935

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Stella ElizabethKeizer

Born at Gold River in the County of Lunenburg

That Stella ElizabethKeizer Whose Birth is sought to be registered was

born at Gold River Lunenburg County on December 20, 1920

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

That I am the mother of Stella Elizabeth Keizer

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