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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000203

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lottie AlytheCoombs Sex Female

Date of Birth October 31, 1920 Place of Birth Lake JollyCounty of Annapolis

Name of Father Charles Emerson Coombs MAIDEN NAME of Mother Vada Maud Wamboldt

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

Residence of Father when child was born Lake Jolly Present address of Father Bear River

Occupation of Father at Birth of child Carpenter Place of birth of Father Virginia East

Race White Name and present address of Physician in attendance at birth Dr. J.L. Louett Bear River

Signature of Applicant Charles E. Coombs Address of Applicant Bear River Date July 4, 1953

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lottie AlytheCoombs

Born at Lake Jolly in the County of Annapolis

That Lottie AlytheCoombs Whose Birth is sought to be registered was

born at Lake Jolly Annapolis County on October 31, 1920

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

I am her father and was present at the time of her birth (Census report, school record & family Bible record)

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