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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000136

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean ElizabethDolliver Sex Female

Date of Birth February 22, 1922 Place of Birth BridgewaterCounty of Lunenburg

Name of Father Starratt Everett Dolliver MAIDEN NAME of Mother Jennie Sarah Lawson

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

Residence of Father when child was born Bridgewater, Lunenburg Present address of Father Bridgewater, Lunenburg

Occupation of Father at Birth of child Trainman - Canadian National Railway Place of birth of Father Bridgewater, Lunenburg

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jennie S. Dolliver Address of Applicant Bridgewater, Lunenburg Date 9 June 1952

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean ElizabethDolliver

Born at Bridgewater in the County of Lunenburg

That Jean ElizabethDolliver Whose Birth is sought to be registered was

born at Bridgewater Lunenburg County on February 22, 1922

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

That I am the mother of the said Jean Elizabeth Dolliver (certificate from records of attending midwife)

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