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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000438

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Annie MayFalls Sex Female

Date of Birth November 15, 1920 Place of Birth Western HeadCounty of Queens

Name of Father Thomas Reginald Falls MAIDEN NAME of Mother Reta Emma Harper

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

Residence of Father when child was born Western Head Present address of Father deceased

Occupation of Father at Birth of child Foundry Worker Place of birth of Father Milton

Race Negro Name and present address of Physician in attendance at birth Dr. Hennigar, deceased

Signature of Applicant Annie May Lee Address of Applicant Liverpool Date November 14, 1966

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Annie MayFalls

Born at Western Head in the County of Queens

That Annie MayFalls Whose Birth is sought to be registered was

born at Western Head Queens County on November 15, 1920

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

1. Certificate from Liverpool Elementary Schools 2. Notarial Certificate of Entry in Bible of Mary Wardington, Foster Grandmother of Annie May Falls.

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