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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000700

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Donald HerbertWallace Sex Male

Date of Birth October 29, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father Herbert Carney Wallace MAIDEN NAME of Mother Hattie May Willnoff

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

Residence of Father when child was born 370 Portland St. Dartmouth Present address of Father deceased

Occupation of Father at Birth of child Plumber Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Donald Herbert Wallace Address of Applicant 24 Whittier Rd. Natick, Massachusetts, USA Date July 11, 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Donald HerbertWallace

Born at Dartmouth in the County of Halifax

That Donald HerbertWallace Whose Birth is sought to be registered was

born at Dartmouth Halifax County on October 29, 1921

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

Immigration papers Marriage record Baptism Certificate

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