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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200512

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 31, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Robert Theodore Muise MAIDEN NAME of Mother Lena B Bennett

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

Residence of Father when child was born Halifax Present address of Father 5 Victoria Rd.

Occupation of Father at Birth of child Conductor Place of birth of Father Belleville, Yarmouth Co.

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

Signature of Applicant Robert Theodore Muise Address of Applicant 5 Victoria Rd. Date 26 January 1920

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Halifax in the County of Halifax

That Dorothy MayMuise Whose Birth is sought to be registered was

born at Halifax Halifax County on December 31, 1919

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

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