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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000067

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Georgina ByrnesSmith Sex Female

Date of Birth June 3, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father Vernon Smith MAIDEN NAME of Mother Veronica Hendley

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

Residence of Father when child was born Shaw Road Dartmouth Present address of Father 47 South St. Foxboro, Massachusetts, USA

Occupation of Father at Birth of child Shipfitter Place of birth of Father Dartmouth

Race White Name and present address of Physician in attendance at birth Dr. Byrnes

Signature of Applicant Georgina B. Piasecki Address of Applicant No. Main St. Mansfield, Massachusetts, USA Date June 28, 1947

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Georgina ByrnesSmith

Born at Dartmouth in the County of Halifax

That Georgina ByrnesSmith Whose Birth is sought to be registered was

born at Dartmouth Halifax County on June 3, 1921

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

Enclosed Photocopy of Certificate of Baptism from Parish of Christ Church, Dartmouth

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