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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000821

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of PaulineSmith Sex Female

Date of Birth August 9, 1921 Place of Birth North PrestonCounty of Halifax

Name of Father Demus Smith MAIDEN NAME of Mother Susan Bundy

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

Residence of Father when child was born North Preston Present address of Father deceased

Occupation of Father at Birth of child Labourer Place of birth of Father North Preston

Race Name and present address of Physician in attendance at birth

Signature of Applicant Pauline Willis Address of Applicant Box 2623 Dartmouth Date March 3, 1979

Relationship of Applicant to child n/a

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of PaulineSmith

Born at North Preston in the County of Halifax

That PaulineSmith Whose Birth is sought to be registered was

born at North Preston Halifax County on August 9, 1921

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

I have been aware of Aug 9, 1921 as been my date of birth and I have always used that date School Record Census Record

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