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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000211

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Doris DorothyGould Sex Female

Date of Birth September 6, 1922 Place of Birth AmherstCounty of Cumberland

Name of Father   MAIDEN NAME of Mother Nellie Gould

Were the Parents married at the time of the Birth? No

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 Dorris Dorothy Gould Address of Applicant 10 Elm Street, Toronto, Ontario Date 26 June 1956

Relationship of Applicant to child one and the same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Doris DorothyGould

Born at Amherst in the County of Cumberland

That Doris DorothyGould Whose Birth is sought to be registered was

born at Amherst Cumberland County on September 6, 1922

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

I was told so by my uncle George Lee, who brought me up, and subsequently I read the same on my baptismal certificate which is being forwarded direct from the church to you, being St. Charles Church, Amherst

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