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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500057

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Phyllis GeorgenaPolley Sex Female

Date of Birth October 29, 1919 Place of Birth WallaceCounty of Cumberland

Name of Father Fred Polley MAIDEN NAME of Mother Louise Lunholm

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

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

Occupation of Father at Birth of child Carpenter Place of birth of Father Bayside, NB

Race Name and present address of Physician in attendance at birth Dr. F.D. Chairman

Signature of Applicant Fred Polley Address of Applicant Wallace Date 12 March 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Phyllis GeorgenaPolley

Born at Wallace in the County of Cumberland

That Phyllis GeorgenaPolley Whose Birth is sought to be registered was

born at Wallace Cumberland County on October 29, 1919

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

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