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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900116

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Glenn WilliamDorman Sex Male

Date of Birth April 3, 1920 Place of Birth NewtonvilleCounty of Kings

Name of Father William Allister Dorman MAIDEN NAME of Mother Carrie Grace Caldwell

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

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

Occupation of Father at Birth of child Farmer Place of birth of Father Hantsport

Race British Name and present address of Physician in attendance at birth none

Signature of Applicant Carrie G. Dorman Address of Applicant Newtonville Date May 22, 1945

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Glenn WilliamDorman

Born at Newtonville in the County of Kings

That Glenn WilliamDorman Whose Birth is sought to be registered was

born at Newtonville Kings County on April 3, 1920

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

I am his mother and I know the facts

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