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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000405

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy JosephineArthur Sex

Date of Birth December 18, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father Blank Blank MAIDEN NAME of Mother Daisy Arthur

Were the Parents married at the time of the Birth?

Residence of Father when child was born Blank Present address of Father Blank

Occupation of Father at Birth of child Blank Place of birth of Father Blank

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

Signature of Applicant Dorothy J. Cooke Address of Applicant R.R. #2, Lr. Sackville Date December 11, 1964

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy JosephineArthur

Born at Halifax in the County of Halifax

That Dorothy JosephineArthur Whose Birth is sought to be registered was

born at Halifax Halifax County on December 18, 1920

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

Information received from foster parents and from the attached baptism certificate and photocopy of an adoption order.

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