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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000199

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mildred Marie (Mary)Kinsman (now Houck) Sex Female

Date of Birth February 9, 1922 Place of Birth BilltownCounty of Kings

Name of Father   MAIDEN NAME of Mother Marion Kinsman

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bessie Houck Address of Applicant 2 Harvard Place, Worcester, Massachusetts, USA Date 12 December 1955

Relationship of Applicant to child Adopting parent

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mildred Marie (Mary)Kinsman (now Houck)

Born at Billtown in the County of Kings

That Mildred Marie (Mary)Kinsman (now Houck) Whose Birth is sought to be registered was

born at Billtown Kings County on February 9, 1922

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

I am ehr adopted mother and was given this date as the date of her birth at the time I took her as a very young child. Also, the record of the attending physician bears out this fact.

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