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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000997

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy Belle Smith Sex Female

Date of Birth May 9, 1921 Place of Birth Harmony MillsCounty of Queens

Name of Father Frederick William Smith MAIDEN NAME of Mother Mildred Maude Mansfield

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

Residence of Father when child was born Harmony Mills Present address of Father deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sarah Minard Address of Applicant RR1 Caledonia Date August 7, 1982

Relationship of Applicant to child Niece

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy Belle Smith

Born at Harmony Mills in the County of Queens

That Dorothy Belle Smith Whose Birth is sought to be registered was

born at Harmony Mills Queens County on May 9, 1921

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

I was in the home of Frederick William Smith and my sister Mildred Maud Mansfield Smith and assisted Dr. A.C. MacLeod when Dorothy Belle Smith was born in Harmony Mills, Queens. I can well remember the birth and dates

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