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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200324

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Violet ChristinaLarson Sex Female

Date of Birth November 28, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Ernest L Larson MAIDEN NAME of Mother Eva M Simmonds

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

Residence of Father when child was born Halifax Present address of Father 30 West St.

Occupation of Father at Birth of child Longshoreman Place of birth of Father Sweden

Race Name and present address of Physician in attendance at birth Dr. Thomas

Signature of Applicant Ernest L. Larson Address of Applicant 30 West St. Date 12 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Violet ChristinaLarson

Born at Halifax in the County of Halifax

That Violet ChristinaLarson Whose Birth is sought to be registered was

born at Halifax Halifax County on November 28, 1919

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

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