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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200311

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of June OctaviaDouglas Sex Female

Date of Birth November 26, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Peter Gerald Douglas MAIDEN NAME of Mother Henrietta D Rabasse

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

Residence of Father when child was born Dartmouth Present address of Father

Occupation of Father at Birth of child Chauffeur Place of birth of Father Dartmouth

Race Name and present address of Physician in attendance at birth Dr. A. J. Mader

Signature of Applicant Peter Gerald Douglass Address of Applicant 137 Morris St. Date 06 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of June OctaviaDouglas

Born at Halifax in the County of Halifax

That June OctaviaDouglas Whose Birth is sought to be registered was

born at Halifax Halifax County on November 26, 1919

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

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