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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000900

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Orpha ChurchillHiltz Sex

Date of Birth August 2, 1920 Place of Birth Dalhousie EastCounty of Kings

Name of Father Ray  Hiltz MAIDEN NAME of Mother Ella Kaulback Hiltz

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

Residence of Father when child was born Dalhousie East Present address of Father deceased

Occupation of Father at Birth of child Lumberman/farmer Place of birth of Father Dalhousie East

Race Name and present address of Physician in attendance at birth

Signature of Applicant Orpha C. Hiltz DeWinter Address of Applicant Springfield Date February 28, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Orpha ChurchillHiltz

Born at Dalhousie East in the County of Kings

That Orpha ChurchillHiltz Whose Birth is sought to be registered was

born at Dalhousie East Kings County on August 2, 1920

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

My mother has explained that my birth was recorded in your office under the name Marjorie Jaunita Hiltz, my parents later changed the name to Orpha Churchill Hiltz. I was baptized on November 14, 1920 as Orpha Churchill Hiltz have always been known by that name, married September 14, 1940 and have five children whose births are registered.

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