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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000353

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mildred MadelineKing Sex Female

Date of Birth September 3, 1921 Place of Birth AvonportCounty of Kings

Name of Father Douglas Burton King MAIDEN NAME of Mother Evangeline Mary Vangy  Kelly

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

Residence of Father when child was born Avonport Present address of Father dead

Occupation of Father at Birth of child Labourer Place of birth of Father Avonport

Race White Name and present address of Physician in attendance at birth Midwife (Grandmother)(dead)

Signature of Applicant Mrs. B. Carlton Davies Address of Applicant Hantsport Date May 3, 1966

Relationship of Applicant to child Cousin

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mildred MadelineKing

Born at Avonport in the County of Kings

That Mildred MadelineKing Whose Birth is sought to be registered was

born at Avonport Kings County on September 3, 1921

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

I was living in the same home when she was born and was there at the time of her birth.

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