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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93602299

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Willard AnselTaylor Sex Male

Date of Birth December 18, 1906 Place of Birth Lower Five IslandsCounty of Colchester

Name of Father Willard Ansel Taylor MAIDEN NAME of Mother Rachel Lewis

Residence of Father when child was born Lower Five Islands Present address of Father Lower Five Islands

Occupation of Father at Birth of child Firing in mill Place of birth of Father Five Islands

Race English Name and present address of Physician in attendance at birth Della Lewis, midwife

Signature of Applicant Rachel Taylor Address of Applicant Lower Five Islands Date 5 April 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Willard AnselTaylor

Born at Lower Five Islands in the County of Colchester

That Willard AnselTaylor Whose Birth is sought to be registered was

born at Lower Five Islands Colchester County on December 18, 1906

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

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