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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000223

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 6, 1920 Place of Birth Pleasant River County of Queens

Name of Father Fred Smith MAIDEN NAME of Mother Gladys Bernice  Goucher

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

Residence of Father when child was born Pleasant River Present address of Father Pleasant River

Occupation of Father at Birth of child farmer Place of birth of Father Pleasant River

Race White Name and present address of Physician in attendance at birth Dr. J. B. March deceased

Signature of Applicant Gladys B. Smith Address of Applicant Pleasant River Date May 8 , 1957

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen Shirley Smith

Born at Pleasant River in the County of Queens

That Helen Shirley Smith Whose Birth is sought to be registered was

born at Pleasant River Queens County on December 6, 1920

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

By being the mother of the child. School record, family bible.

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