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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500196

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 31, 1919 Place of Birth AmherstCounty of Cumberland

Name of Father Folton Leo Simmonds MAIDEN NAME of Mother Stella May Dixon

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 Plumber Place of birth of Father Canning

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

Signature of Applicant Folton Leo Simmonds Address of Applicant Amherst Date 13 January 1920

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Amherst in the County of Cumberland

That Dorothy MaySimmonds Whose Birth is sought to be registered was

born at Amherst Cumberland 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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