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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000619

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Eleanor MayStates Sex Female

Date of Birth December 30, 1920 Place of Birth AvonportCounty of Kings

Name of Father Walter Edward States MAIDEN NAME of Mother Ada MAy Upshaw

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

Residence of Father when child was born Avonport Present address of Father deceased

Occupation of Father at Birth of child Logger Place of birth of Father Avonport

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

Signature of Applicant Oscar Adelbert States Address of Applicant Vancouver Date December 18, 1972

Relationship of Applicant to child brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Eleanor MayStates

Born at Avonport in the County of Kings

That Eleanor MayStates Whose Birth is sought to be registered was

born at Avonport Kings County on December 30, 1920

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

I was present at the birth of Eleanor May States and that I have personal knowledge of the facts of birth.

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