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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100292

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lottie MaeTaylor Sex Female

Date of Birth May 27, 1920 Place of Birth South BerwickCounty of Kings

Name of Father Frederick Taylor MAIDEN NAME of Mother Jean Veinotte

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

Residence of Father when child was born South Berwick Present address of Father South Berwick

Occupation of Father at Birth of child Farmer Place of birth of Father Rockland

Race Canadian Name and present address of Physician in attendance at birth Dr. Paul Balcome, deceased

Signature of Applicant Frederick Taylor Address of Applicant South Berwick Date July 23, 1946

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lottie MaeTaylor

Born at South Berwick in the County of Kings

That Lottie MaeTaylor Whose Birth is sought to be registered was

born at South Berwick Kings County on May 27, 1920

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

I am the lawful father of said Lottie Mae Taylor and have a personal knowledge of the facts herein defined.

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