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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000236

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Madeline AnnSmith Sex Female

Date of Birth July 26, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father James William Smith MAIDEN NAME of Mother Mary Penticost

Residence of Father when child was born Sydney Present address of Father Halifax

Occupation of Father at Birth of child Travelling Salesman Place of birth of Father Goldenville

Race White Name and present address of Physician in attendance at birth Dr. Walsh, Sydney

Signature of Applicant J.W. Smith Address of Applicant 43 Quinn St. Halifax Date December 6, 1941

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Madeline AnnSmith

Born at Sydney in the County of Cape Breton

That Madeline AnnSmith Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 26, 1920

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

I am her Father and being home at the time well remember the particulars of her birth

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