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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000252

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Arthur Lloyd GeorgeCollicott Sex Male

Date of Birth January 1, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father Charles Frederick Collicott MAIDEN NAME of Mother Nora Loella Boutilier

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

Residence of Father when child was born Elmwood Ave. Dartmouth Present address of Father 137 Herring Cove Rd. Armdale

Occupation of Father at Birth of child Soldier Place of birth of Father Devonport, England

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

Signature of Applicant Mrs. Nora Collicott Address of Applicant 137 Herring Cove Rd. Armdale Date January 28, 1958

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Arthur Lloyd GeorgeCollicott

Born at Dartmouth in the County of Halifax

That Arthur Lloyd GeorgeCollicott Whose Birth is sought to be registered was

born at Dartmouth Halifax County on January 1, 1921

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

I gave birth to the above name son, at Elmwood Ave. Dartmouth with Dr. Simpson in attendance Church Record Marriage Record

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