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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500227

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AmyLaurie Sex Female

Date of Birth December 10, 1919 Place of Birth Springhill MinesCounty of Cumberland

Name of Father John Gibson Laurie MAIDEN NAME of Mother Amy Bock

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

Residence of Father when child was born Springhill Mines Present address of Father Junction Rd.

Occupation of Father at Birth of child Shoemaker Place of birth of Father Glasgow, Scotland

Race Name and present address of Physician in attendance at birth Dr. M.J. Wardrope

Signature of Applicant John Gibson Laurie Address of Applicant Springhill Mines Date 17 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AmyLaurie

Born at Springhill Mines in the County of Cumberland

That AmyLaurie Whose Birth is sought to be registered was

born at Springhill Mines Cumberland County on December 10, 1919

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

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