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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000258

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marjorie Dora Simpson Sex Female

Date of Birth January 27, 1920 Place of Birth North BrookfieldCounty of Queens

Name of Father LaMont  Simpson MAIDEN NAME of Mother Lottie Lloyd

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

Residence of Father when child was born North Brookfield Present address of Father deceased

Occupation of Father at Birth of child Miner Place of birth of Father North Brookfield

Race Name and present address of Physician in attendance at birth Deceased

Signature of Applicant Marjorie Dora Meisner Address of Applicant Granville Ferry Date May 30, 1956

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marjorie Dora Simpson

Born at North Brookfield in the County of Queens

That Marjorie Dora Simpson Whose Birth is sought to be registered was

born at North Brookfield Queens County on January 27, 1920

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

Personal Knowledge I have always called myself Marjorie Dorothy and not Marjorie Dora only for the reason that I prefer the name Dorothy. Marriage Record. Census Record.

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