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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000185

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robert MarshallBollivar Sex Male

Date of Birth February 23, 1921 Place of Birth Conquerall MillsCounty of Lunenburg

Name of Father Solomon Bollivar MAIDEN NAME of Mother Ruby Rafuse

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

Residence of Father when child was born Conquerall Present address of Father Conquerall

Occupation of Father at Birth of child Farmer Place of birth of Father Conquerall

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

Signature of Applicant Solomon Bollivar Address of Applicant Conquerall Date August 21, 1954

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robert MarshallBollivar

Born at Conquerall Mills in the County of Lunenburg

That Robert MarshallBollivar Whose Birth is sought to be registered was

born at Conquerall Mills Lunenburg County on February 23, 1921

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

That I am his father together with a certificate of his baptism taken from the records of Ascension Lutheran Church.

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