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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100410

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy MarySmith Sex Female

Date of Birth February 27, 1920 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father John Allan Smith MAIDEN NAME of Mother Sarah McInnis

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

Residence of Father when child was born Reserve Mines Present address of Father

Occupation of Father at Birth of child Place of birth of Father Port Morien

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dorothy Smith McInnis Address of Applicant Reserve Mines Date September 16, 1999

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Reserve Mines in the County of Cape Breton

That Dorothy MarySmith Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on February 27, 1920

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

Surname registered as Mac should be Mc

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