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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91703972

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Helen PatriciaSamuels Sex Female

Date of Birth July 23, 1920 Place of Birth DartmouthCounty of Halifax

Name of Father Wilford Martin Samuels MAIDEN NAME of Mother Edith Priscilla Bauld

Residence of Father when child was born Dartmouth Present address of Father Dartmouth

Occupation of Father at Birth of child Canadian National Railway Porter Place of birth of Father British West Indies

Race African Name and present address of Physician in attendance at birth Dr. Dickson

Signature of Applicant Edith Samuels Address of Applicant Dartmouth Date September 23, 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen PatriciaSamuels

Born at Dartmouth in the County of Halifax

That Helen PatriciaSamuels Whose Birth is sought to be registered was

born at Dartmouth Halifax County on July 23, 1920

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

That I am the mother of the above mentioned.

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