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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700531

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 30, 1919 Place of Birth Glace BayCounty of Cape Breton

Name of Father Charles Tiller MAIDEN NAME of Mother Deborah Green

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

Residence of Father when child was born Glace Bay Present address of Father Mechanics Row

Occupation of Father at Birth of child Car repairer Place of birth of Father Wesleyville, Nfld

Race Name and present address of Physician in attendance at birth Dr. F.G. MacAskill

Signature of Applicant Charles Tiller Address of Applicant Mechanics Row, Glace Bay Date 31 October 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That CharityTiller Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on October 30, 1919

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

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