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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000132

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Queenie LouiseDaw Sex Female

Date of Birth August 4, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father Samuel Daw MAIDEN NAME of Mother Louise Butt

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

Residence of Father when child was born Newfoundland Present address of Father deceased

Occupation of Father at Birth of child Soldier Place of birth of Father St. Johns, Newfoundland

Race English Name and present address of Physician in attendance at birth Mrs. Kelly midwife

Signature of Applicant Mrs. Ralph Jewers Address of Applicant 18 Hunter St. Halifax Date April 19, 1938

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Queenie LouiseDaw

Born at Halifax in the County of Halifax

That Queenie LouiseDaw Whose Birth is sought to be registered was

born at Halifax Halifax County on August 4, 1920

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

Certificate of Baptism attached

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