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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500012

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Iveine EloineRoy Sex Female

Date of Birth October 10, 1919 Place of Birth AmherstCounty of Cumberland

Name of Father Adolphus Roy MAIDEN NAME of Mother Mary Brum

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

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

Occupation of Father at Birth of child labourer Place of birth of Father Moncton, NB

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

Signature of Applicant Adolphus Roy Address of Applicant Amherst Date 09 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Iveine EloineRoy

Born at Amherst in the County of Cumberland

That Iveine EloineRoy Whose Birth is sought to be registered was

born at Amherst Cumberland County on October 10, 1919

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

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