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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700590

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 16, 1919 Place of Birth WestmountCounty of Cape Breton

Name of Father Thomas Hobbs Kelsey Southley MAIDEN NAME of Mother Mabel Olive Fuller

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

Residence of Father when child was born Sydney Present address of Father West Mount

Occupation of Father at Birth of child Electrician Place of birth of Father Chelsea, London

Race Name and present address of Physician in attendance at birth Dr. E.M. McDonald

Signature of Applicant Thomas Hobbs Kelsey Southley Address of Applicant West Mount, Sydney Date 31 January 1920

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Westmount in the County of Cape Breton

That Phyllis MaySouthley Whose Birth is sought to be registered was

born at Westmount Cape Breton County on October 16, 1919

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

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